Successful laparoscopic bipolar coagulation of a large arteriovenous malformation due to invasive trophoblastic disease: a case report

J Minim Invasive Gynecol. 2009 May-Jun;16(3):368-71. doi: 10.1016/j.jmig.2009.01.012.

Abstract

We report the case of an acquired large arteriovenous malformation due to invasive gestational trophoblastic tumor that was treated successfully with laparoscopic surgery. After 4 cycles of methotrexate chemotherapy, a vascular tangle (volume, 28 cm(3)) was noted that emerged from the right uterine horn, invading the broad ligament adjacent to the uterine artery. Doppler ultrasonography along with magnetic resonance arteriography confirmed the diagnosis. The location, size and relation of this arteriovenous malformation to the uterine vasculature demanded urgent intervention. Laparoscopy was performed, and bipolar coagulation of the ovarian and uterine artery feeding branches was achieved after surgical resection of the tumor. The defect in the uterine wall with an intact uterine cavity was reconstructed using sutures. There were no intraoperative or postoperative complications. The patient underwent chemotherapy, and at 2-month follow-up was cured and has since had regular menstrual cycles.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antimetabolites, Antineoplastic / therapeutic use
  • Arteriovenous Fistula / complications
  • Arteriovenous Fistula / pathology
  • Arteriovenous Fistula / surgery*
  • Female
  • Gestational Trophoblastic Disease / complications
  • Gestational Trophoblastic Disease / drug therapy
  • Gestational Trophoblastic Disease / surgery*
  • Humans
  • Hysterotomy
  • Laparoscopy / methods*
  • Methotrexate / therapeutic use
  • Ovary / blood supply
  • Pregnancy
  • Uterus / blood supply

Substances

  • Antimetabolites, Antineoplastic
  • Methotrexate