Successful Control of Post-Hysterectomy Hemorrhage Using Embolization and Transvaginal Glue embolization in Choriocarcinoma - A Case Report

Abstract

Gestational choriocarcinoma is a rare but aggressive trophoblastic tumor characterized by early hematogenous spread and high vascularity. We report a case of a 35-year-old female with known gestational choriocarcinoma who underwent total abdominal hysterectomy due to uncontrolled vaginal bleeding. During surgery, both internal iliac arteries were ligated to control hemorrhage. Postoperatively, persistent pelvic bleeding continued. Computed tomography angiography revealed multiple serpiginous vascular channels and a pseudoaneurysm arising from the left internal iliac artery region. Transarterial embolization was attempted via right common femoral artery access using a C2 catheter. Angiography demonstrated a left internal iliac artery pseudoaneurysm supplied indirectly through gluteal collateral branches. These vessels were coil-embolized. Due to complex collateral circulation, a transvaginal ultrasound-guided direct puncture approach was undertaken, and glue embolization of the pseudoaneurysm was performed successfully. Hemostasis was achieved. This case highlights multidisciplinary hemorrhage control in advanced pelvic vascular pathology associated with gestational choriocarcinoma.