Conservative treatment for hypervascularised placental polyp with secondary haemoperitoneum: a case report.

Conservative treatment for hypervascularised placental polyp with secondary haemoperitoneum: a case report.

Authors

  • Maurizio Di Serio Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma
  • Vito Andrea Capozzi Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma
  • Roberto Berretta Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma
  • Carla Marcato Department of Radiology, University Hospital of Parma
  • Andrea Dall'Asta Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology University of Parma
  • Tiziana Frusca Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology University of Parma

Keywords:

retained products of conception, ERPC, uterine artery embolization, early pregnancy complications, interventional radiology.

Abstract

Objective: We describe the first case to our knowledge of Hypervascularised placental polyp (HPP) presenting with acute pelvic pain and hemoperitoneum. Case Report: A 33 years-old woman with a history of medical abortion three months earlier came to our attention complaining acute pelvic pain and vaginal bleeding. Transvaginal (TV) and transabdominal (TA) ultrasound (US) demonstrated a highly vascular intrauterine lesion and intra-abdominal free fluid consistent with a diagnosis of haemoperitoneum. Emergency laparoscopy yielded no intra-abdominal bleeding and was followed by bilateral selective embolization of the uterine arteries due to persistent vaginal bleeding. Hysteroscopy and pathology findings were consistent with a final diagnosis of HPP. Conclusion: HPP may occur months or years after pregnancy or abortion and the clinical picture of abnormal vaginal bleeding associated with acute abdominal pain and haemoperitoneum should warrant to consider HPP among the differential diagnosis. Clinical and imaging findings need to be considered when planning the conservative management of HPP. Our experience suggests that uterine artery embolization is a safe and effective for the conservative treatment of highly vascularized HPP.

References

H. T. Hagstrom, “Late puerperal hemorrhage due to placental polyp,” Am. J. Obstet. Gynecol., vol. 39, no. 5, pp. 879–881, 1940.

F. Campos, R. Simões, A. Felipe-Silva, M. Gonzales, and E. Ilário, “Placental polyp : a rare cause of iron deficiency anemia.,” Autops Case Rep., vol. 1, no. 4, pp. 51–56, 2011.

T. Ishihara, H. Kanasaki, A. Oride, T. Hara, and S. Kyo, “Differential diagnosis and management of placental polyp and uterine arteriovenous malformation: Case reports and review of the literature,” Women’s Heal., vol. 12, no. 6, pp. 538–543, 2016.

M. Mori et al., “Choosing the optimal therapeutic strategy for placental polyps using power Doppler color scoring: Transarterial embolization followed by hysteroscopic resection or expectant management?,” Taiwan. J. Obstet. Gynecol., vol. 55, no. 4, pp. 534–538, 2016.

Y. Kanaoka, T. Maeda, Y. Nakai, M. Manaka, and S. Ogita, “Placental polyp: power Doppler imaging and conservative resection The,” Ultrasound Obs. Gynecol, no. 11, pp. 225–227, 1998.

K. Hiraki, K. N. Khan, M. Kitajima, A. Fujishita, and H. Masuzaki, “Uterine preservation surgery for placental polyp,” J. Obstet. Gynaecol. Res., vol. 40, no. 1, pp. 89–95, 2014.

K. Y. Ryu, S. R. Kim, S. H. Cho, and S. Song, “Preoperative Uterine Artery Embolization and Evacuation in the Management of Cervical Pregnancy : Report of Two Cases,” pp. 801–804, 2001.

K. Takeuchi, M. Sugimoto, K. Kitao, S. Yoshida, and T. Maruo, “Pregnancy outcome of uterine arterial embolization followed by selective hysteroscopic removal of a placental polyp,” Acta Obstet. Gynecol. Scand., vol. 86, no. 1, pp. 22–25, 2007.

Downloads

Published

30-04-2021

How to Cite

1.
Di Serio M, Capozzi VA, Berretta R, Marcato C, Frusca T. Conservative treatment for hypervascularised placental polyp with secondary haemoperitoneum: a case report. Acta Biomed [Internet]. 2021 Apr. 30 [cited 2024 Jul. 20];92(S1):e2021157. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/9559