A 28-year-old Caucasian woman, gravida 0 para 0, with regular menses, was diagnosed with “undifferentiated squamous carcinoma of the cervix” after a biopsy was performed.
MRI of the abdomen confirmed the presence of an expansive exocervical formation located posteriorly with a maximum diameter of 2
cm. MRI staging: Figo stage IB.
Metastatic work-up, including computed tomography of thorax and abdomen, was negative.
The procedure included bilateral radical pelvic lymphadenectomy and extrafascial trachelectomy. Body mass index of 39 was not considered a contra-indication for laparoscopy, which was successfully performed in order to remove pelvic lymph nodes. Total operative time was 3½ hours. Blood loss was 150
mL. Histological examination revealed a poorly differentiated squamous cell carcinoma of the cervix. Lymph-vascular space invasion (LVSI) was negative. Tumor stage was pT1B, G3, pN0 (pelvic nodes 0/35), IB (Ajcc 2010).
Early postoperative course was uneventful. The patient was discharged after three days.
One month later, the patient presented with massive lymphedema of the right inferior limb. Imaging showed deep femoral vein thrombosis; anticoagulants were administered. CT scans of the abdomen showed a fluid-filled pelvic mass (measuring 15
cm) lying on the psoas major (Figure ).
A pelvic drain was placed into the mass under fluoroscopic guide.
Nevertheless, the patient was soon readmitted for pelvic pain associated with the signs of a thrombophlebitis of the right thigh.
Imaging demonstrated that a lymphocele kept dislocating the iliac vein and compressed the iliac artery posteriorly. Anticoagulants were administered at a higher dose. The pelvic drain was replaced and the patient was discharged in good condition after 20
Fifteen days later the patient presented spontaneously at the emergency department after noticing blood traces in the pelvic drain. CT scan with contrast demonstrated active bleeding at the psoas major area (Figure ).
Active bleeding in the iliopsoas compartment.
The interventional radiologist was, therefore, alerted and emergency surgery was planned. Before entering the operating theater, the patient suffered massive blood loss from the pelvic drain (the sac filled 800
cc in five minutes). Arteriography demonstrated a ruptured pseudo-aneurysm of the external iliac artery on the right side (Figure ). A lesion in the vessel wall was clearly seen in the posterior aspect of the artery (Figure ). A covered stent (Gore® Viabahn® W. L. Gore & Associates, Inc. Medical Products Division Arizona USA), measuring 7
mm in diameter and 50
mm long, was placed after percutaneous transluminal angioplasty (PTA) with a balloon catheter (Invatec Admiral Xtreme™ (INVATEC Inc. Bethlehem, Pennsilvania USA) Postoperatively the patient recovered well and had no further complications after four months of follow-up.
False aneurysm of the external iliac artery.