POST-PARTUM HEMORRHAGE WITH MASSIVE HEMOPERITONEUM FROM INFERIOR EPIGASTRIC ARTERIES AFTER CAESAREAN SECTION- A CASE REPORT

Abstract

Post-partum hemorrhage from inferior epigastric artery after a caesarean section is a rare occurrence and as such has a high potential for both misdiagnosis and delayed diagnosis. Inferior epigastric vascular injury occurs during the dissection and separation of the anterior abdominal walls and has tendency for increased morbidity and mortality in the background of anticoagulation. A high index of suspicion is needed with hemodynamic instability post caesarean section in the absence of vaginal bleeding and surgical intervention is needed in such cases to avert dreadful outcome. Presented in this report was a 37-year-old who had elective repeat caesarean section but developed massive hemoperitoneun with severe anaemia after 48 hours. She had surgical intervention to arrest the bleeding epigastric vessels and made good recovery.  

Keywords:

Inferior epigastric artery, post-partum hemorrhage, hemoperitoneum, rectus sheath hematoma

References

Montufar-Rueda C, Rodriguez L, Jarquin JD, Barboza A, Bustillo MC, Marin F, et al. Severe postpartum hemorrhage from uterine atony: a multicentric study. J Pregnancy 2013; 2013: 525914. doi: 10.1155/2013/525914. Epub 2013 Dec 2. PMID: 24363935; PMCID: PMC3864080.

Chavan N, Kampoowale S, Ammara U, Kapote D, Sakhalkar A. A rare lifethreatening rectus sheath haematoma in post lower segment cesarean section patient: a case report. Int J Reprod Contracept Obstet Gynecol 2022; 11:1795-8. doi: https://dx.doi.org/10.18203/2320-1770.ijrcog20221463.

Allen M, Sevensma KE. Rectus sheath hematoma. 2023 Jan 30 In: StatPearls [internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 30085575.

Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006;85(2):105-10. doi: 10. 1087/01.md.0000216818. 13067.5a. PMID: 16609349.

Sobkin PR, Bloom AI, Wilson MW, LaBerge JM, Hastings GS, Sheth HS, et al. Massive abdominal wall hemorrhage from injury to the inferior epigastric artery: a retrospective review. J Vasc Interv Radiol. 2008;19(3):327-32. doi: 10. 1016/j.jvir.2007.11.004. PMID: 18295690.

Ko SF, Lin H, Ng SH, Lee TY, Wan YL. Postpartum hemorrhage with concurrent massive inferior epigastric artery bleeding after cesarean delivery. Am J Obstet Gynecol. 2002; 187: 243-4. doi: 10. 1067/mob.2002. 122417. PMID: 12114920.

Ko SY, Park SW, Sohn IS, Lee JY, Kwon HS, Hwang HS, et al. Interventional management for complications following caesarean section. Br J Radiol. 2011; 84: 204-9. doi: 10. 1259/bjr/53617758. Epub 2010 oct 19. PMID: 20959367; PMCID: PMC3473877.

Yalamanchili S, Harvey SM, Friedman A, Shams JN, Silberzweig JE. Transarterial embolization for inferior epigastric artery injury. Vasc Endovascular Surg. 2008; 42: 489-93. doi: 10. 1177/1538574408316144. PMID: 19000984.

Kamboj S, Pal N, Arora BK. Rectus sheath hematoma in post-lower segment caesarean section patient. Int Surg J 2024; 11:1027-8. doi: https://dx.doi.org/10.18203/2320-1770.ijrcog20221463.

Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: a review of the literature. Int J Surg. 2015; 13:267-71. doi: 10. 1016/j.ijsu.2014. 12.015. Epub 2014 dec 19. PMID: 25529279.

Senturk MB, Guraslan H, Polat M, Durukan OB. Postpartum Hemorrhage due to Inferior Epigastric Vein Injury. Sisli Etfal Hastan Tip Bul. 2016;50(1):90-2. doi: 10.5350/SEMB.20151210081626.

Rimola J, Perendreu J, Falcó J, Fortuño JR, Massuet A, Branera J. Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol. 2007;188(6): W497-502. doi: 10.22144/AJR.06.0861. PMID: 17515337.

Sheth HS, Kumar R, DiNella J, Janov C, Kaldas H, Smith RE. Evaluation of Risk Factors for Rectus Sheath Hematoma. Clin Appl Thromb Hemost. 2016;22(3):292-6. doi: 10. 1177/1076029614553024. Epub 2014 Oct 7. PMID: 25294636.

Dubinsky IL. Hematoma of the rectus abdominis muscle: case report and review of the literature. J Emerg Med. 1997;15(2):165-7. doi: 10. 1016/s0736-4679(96)00344-7. PMID: 9144056.