Ovarian Hemorrhage as a Complication of Venovenous Extracorporeal Membrane Oxygenation

Hemorrhage is one of the major complications of extracorporeal membrane oxygenation (ECMO). The most common types of hemorrhagic complications include cannulation site, skin, mucosa, gastrointestinal tract, respiratory tract, and intracranial. There are rare cases of uterine hemorrhage in patients supported by venovenous ECMO. The frequency of gynecologic hemorrhage in patients supported by venovenous ECMO is not well characterized.

A 23-year-old woman presented for elective gastrostomy tube placement and developed acute respiratory distress syndrome requiring initiation of venovenous ECMO to bridge to lung transplantation. Her hemoglobin dropped to 7.5 g/dL on postoperative day 20, and a computed tomography scan showed evidence of a large hemoperitoneum with concern for a ruptured ovarian cyst. The patient underwent right ovarian artery particle embolization to control the bleeding; however, an abdominal washout was required due to increasing bladder pressures. The patient remained hypotensive, requiring pressors, and was deemed to no longer meet criteria for lung transplantation. The patient died on postoperative day 38.

Further investigation is needed to better characterize gynecologic hemorrhage in patients of childbearing age supported by venovenous ECMO.