Transcatheter embolotherapy of massive bleeding after surgery for benign gynecologic disorders

Transcatheter embolotherapy is a well-established technique for control of bleeding in patients with pelvic trauma and pelvic malignancies, but it has been rarely used in massive vaginal bleeding after surgery for benign gynecologic disorders. We report five patients with massive post-operative vaginal hemorrhage following total abdominal hysterectomy (n = 3), repeated dilatation and curettage (n = 1) and cesarean section (n = 1), all successfully controlled with transcatheter embolization after many operative procedures had failed to stop the hemorrhage. The age of the patients ranged from 21 to 36 years. All patients underwent embolization of both internal iliac arteries with Gelfoam alone or in combination with stainless steel coils. The bleeding stopped immediately in all patients. Four patients recovered completely and one patient died of disseminated intravascular coagulation and multi-organ failure.