Ruptured postpartum ovarian artery aneurysm, endovascular limitations and the value of open vascular control

Ruptured ovarian artery aneurysm (OAA) is an exceptionally rare cause of postpartum retroperitoneal hemorrhage and is often difficult to diagnose due to nonspecific presentation. We report a postpartum patient with intermittent symptoms whose computed tomography scan suggested ovarian artery bleeding, followed by an unsuccessful endovascular embolization attempt due to severe vessel tortuosity. She ultimately underwent open surgical exploration with ligation of the ruptured OAA, achieving definitive hemostasis and full recovery. This case highlights the diagnostic challenges of OAA rupture and underscores the importance of prompt operative intervention when endovascular management is not feasible.