A Case of Déjà vu: Surgical Correction of a Uterine AVM and Hysteroscopic Resection of RPOC Secondary
OBJECTIVES: To demonstrate a unique case of both a laparoscopic correction of a uterine AVM and hysteroscopic resection of retained products of conception secondary to invasive placenta.
DESIGN: A Brief Literature Review and Case Report INTERVENTIONS In this video we explore the case of a 28 year-old patient who in 2019 had a 20 week loss followed by PPH requiring manual removal of retained placenta and D&C. Subsequent to this first pregnancy she a delayed PPH with IR embolization of the left uterine artery for a uterine AVM.
In 2020, the patient delivered vaginally, preterm at 27 weeks and again had a PPH requiring manual removal of retained placenta and D&C. After 2 months of continued spotting an ultrasound queried residual RPOC with hypervascularity in the right uterine wall suggestive of a right AVM with CT angiography confirming a uterine AVM. The patient wished for fertility preservation and ultimately underwent laparoscopic clipping of the feeding vessel, the right internal iliac artery followed by hysteroscopic removal of retained products of conception.
The patient’s post-operative course was uncomplicated and final pathology confirmed normal placental tissue consistent with placenta accreta. The post-op sonohysterogram confirmed an empty uterine cavity and the 2D colour doppler US confirmed reduced right uterine wall vascularity. CONCLUSION: A laparoscopic approach to uterine AVM management is possible and can be combined with hysteroscopic investigation and management of RPOC.