A case of delayed postoperative hemorrhage after transcervical resection controlled by transcatheter arterial embolization

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A 37 year old woman, gravida 1, para 0 was referred to our department for persistent hypermenorrhea over the last two years. She had a 2 cm polypoid submucosal uterine leiomyoma. She took dienogest (2mg/d) for two weeks before transcervical resection (TCR), and we enucleated the leiomyoma with placental forceps. On postoperative day 14, after taking oral contraceptives for 10 days, she had sudden massive vaginal bleeding, and was brought back to our hospital. Since the arterial bleeding could not be controlled transvaginally, we performed blood transfusion and emergency transcatheter arterial embolization (UAE). After UAE, the patient had no further bleeding, and she resumed normal menstruation. It is possible to develop massive or delayed postoperative hemorrhage due to vessel injury after TCR, even if the myoma nodule is small. Careful attention should be paid during TCR procedures.