Delayed postpartum abdominal bleeding caused by a spontaneous ruptured branch of the internal iliac artery and successfully treated by arterial embolisation

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A 34-year-old gravida 2 para 1 had an uneventful second pregnancy and successful vaginal birth after caesarean section. She was readmitted on the third day postpartum with severe abdominal pain coinciding with lactation. On admission, her vital signs were stable and was expectantly managed. After an unexpected drop in haemoglobin level, a CT scan was ordered, showing a haemoperitoneum. Laparoscopy was performed and 2.5L of blood was evacuated from the peritoneal cavity, no source of the bleeding could be identified. At the intensive care unit the patient's vital signs deteriorated and her haemoglobin level dropped to 2.2 mmol/L. The patient was stabilised and instead of a laparotomy to locate the bleeding, an arterial CT and angiography were performed. This revealed the presence of a blush from a pseudoaneurysm rising from a branch of the internal iliac artery. The artery was successfully occluded by embolisation.

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