Intraperitoneal hemorrhage following primary cytoreductive surgery for ovarian cancer: Successful treatment with superior epigastric artery embolization A rare case of superior epigastric artery injury

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Vito Andrea Capozzi
Diana Butera
Giulia Armano
Michela Gaiano
Luciano Monfardini
Giulia Gambino
Alessandra Cianciolo
Ilaria Paladini
Enrico Epifani
Roberto Berretta


Hemoperitoneum; Superior epigastric artery bleeding; Embolization; Laparotomic complication.


Hemoperitoneum often occurs due to abdominal trauma, abdominal tumors, gastro-intestinal perforation and more rarely it’s spontaneous due to coagulopathies. Superior epigastric artery (SEA) iatrogenic damage is rarer than the Inferior epigastric artery injury, it may occur during laparotomy and, in most cases, it causes a rectus muscle hematoma. We present the case of a caucasian 44 years-old-woman with hemoperitoneum after cytoreductive surgery for ovarian cancer. Active bleeding from the distal branch of the SEA was diagnosed at computed tomography and coil embolization followed by surgical laparotomic drainage of the hemoperitoneum was performed. After initial resolution, active bleeding from the same vessel was observed. Further embolization of the same vessel was necessary to stop bleeding. Ultrasound follow-up showed a complete resolution of the hemoperitoneum


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1. Park SW, Ko SY, Yoon SY, et al Transcatheter arterial embolization for hemoperitoneum: Unusual manifestation of iatrogenic injury to abdominal muscular arteries. Abdom Imaging 2011 Feb;36(1)74-8.
2. Kumar S, Khanna S, Roy A, Gupta SK. An unusual cause of hemoperitoneum: case report with review of literature. Int J Surg Case Rep 2015; 12 120–122.
3. Tajima S, Yonezawa I, Waki M, Hoshi S. Massive hemoperitoneum following spontaneousrupture of an arterial aneurysm overlyinga uterine myoma. Int J Clin Exp Med 2015; 8(2) 3002–3005
4. Sharzehi K, Jain V, Naveed A, Schreibman I. Hemorrhagic Complications of Paracentesis: A Systematic Review of the Literature. Gastroenterol Res Pr 2014; 2014 985141.
5. O’Dey DM, Heimburg D V., Prescher A, Pallua N. The arterial vascularisation of the abdominal wall with special regard to the umbilicus. Br J Plast Surg 2004 Jul;57(5)392-7.
6. De Rosnay P, Chandiramani M, Usman S, Owen E. Injury of epigastric vessels at laparoscopy: diagnosis and management. Gynecol Surg 8353–356.
7. Funaki B. Embolization iatrogenic hemorrhage after paracentesis. Semin Interv Radiol 2008 Sep; 25(3) 329–333.
8. Saber AA, Meslemani AM, Davis R, Pimentel R. Safety Zones for Anterior Abdominal Wall Entry during Laparoscopy: A CT Scan Mapping of Epigastric Vessels. Ann Surg 2004 Feb; 239(2) 182–185.
9. Fagotti A, Ferrandina G, Fanfani F, et al. A Laparoscopy-Based Score To Predict Surgical Outcome in Patients With Advanced Ovarian Carcinoma: A Pilot Study. Ann Surg Oncol 13:1156–1161.
10. Corvino F, Giurazza F, Cangiano G, et al. Safety and effectiveness of transcatheter embolization in the treatment of internal mammary artery injuries. Radiol Medica 123:369–377.
11. Bilbao JI, Martínez-Cuesta A, Urtasun F, et al. Complications of Embolization. Semin Interv Radiol 2006 Jun; 23(2) 126–142 doi 101055/s-2006-941443
12. Takeuchi Y, Morishita H, Sato Y, et al. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 32, 500–517 (2014) https//

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