Uterine hemangioma

A woman's uterus will suffer certain damage after pregnancy and childbirth, so it is very important to restore the uterus to its original state and protect its function after childbirth. During routine physical examinations, women should also pay more attention to the examination of the uterus and prevent the occurrence of uterine hemangioma. Uterine hemangioma can occur at different ages, and women who are pregnant should pay special attention to it. Women who suffer from uterine hemangioma should pay attention to the following symptoms.

Uterine hemangiomas are less common and include varicose aneurysms, arteriovenous malformations, cavernous hemangiomas, racemose aneurysms, and arteriovenous fistulas. Pathologically, some of these hemangiomas are hamartomas or vascular malformations, but they are generally difficult to distinguish from true tumors. In a broad sense, hemangiomas should include all lesions with abnormal increase in non-reactive blood vessels [1]. Therefore, it may be more appropriate to call it "uterine hemangioma" clinically, which can more comprehensively summarize the various types of this disease.

Occurrence of uterine hemangioma

The incidence and cause of uterine hemangioma are still unclear, and so far only scattered case reports have been made. Foreign literature reports that the age of onset ranges from fetuses at 34 weeks of gestation to postmenopausal women aged 72 years. The disease is more common in women of childbearing age between 20 and 40 years old [2]. The exact cause of uterine hemangioma is still unclear, and it is divided into two types: congenital and acquired. Congenital vascular malformations are caused by abnormalities in the first stage of vascular development during the embryonic period. The tumor originates from vascular endothelial cells and is a common benign vascular tumor. Most cases occur in the myometrium, with the lesions often extending beyond the uterus to the pelvic cavity. The blood supply comes from the pelvic vessels rather than the uterus [3]. Acquired cases are mainly related to trauma (surgery, childbirth, various abortions, curettage, etc.), placement of intrauterine contraceptive devices, infection, maternal use of diethylstilbestrol during pregnancy, and endometrial and cervical malignancies, especially trophoblastic tumors.

Treatment of uterine hemangioma

Generally, there are two types of treatment: conservative treatment and surgical treatment.

Conservative treatment

It is mostly suitable for young patients with mild clinical symptoms, short discovery time, good follow-up conditions, and who require to preserve their fertility. include:

(1) Expectant observation: For patients who have been diagnosed recently and have been effectively treated with conservative treatment, short-term observation and regular follow-up are allowed after hemostasis.

(2) Non-invasive treatment methods (drug therapy.

(3) Invasive treatment methods: Relatively conservative invasive treatment hemostasis measures include placing a Foley balloon into the uterine cavity to compress the bleeding area. With the development of interventional treatment techniques in recent years, uterine artery embolization has become an effective treatment method other than laparotomy, which can control most vaginal bleeding in an emergency[6]. The success rate of pelvic artery embolization performed by Ghai et al [7] was 100%, and the clinical success rate was 93%. Among the 15 patients, only one underwent emergency hysterectomy, and the rest successfully stopped bleeding in a short period of time. Therefore, transcatheter pelvic artery embolization is considered to be a safe and effective treatment method, especially for patients who require preservation of fertility. It is still possible to achieve a successful pregnancy after uterine artery embolization.

Surgical procedures include:

(1) Tumor removal: It is mostly suitable for tumors that are relatively localized and located in the uterine serosa, submucosal, or cervical hemangiomas. The latter two types are not suitable for curettage to avoid damaging blood vessels and causing severe bleeding.

(2) Hysterectomy: Hysterectomy is recommended for patients with diffuse or multiple intramural hemangiomas and those who have failed uterine artery embolization.

(3) In addition, uterine artery and internal iliac artery ligation can be performed, which are often used as emergency hemostasis measures. Case 1 was the first case in our hospital. As the patient was at childbearing age and had insufficient knowledge of the disease and difficulty in diagnosis, pelvic angiography and embolization were the first choice. However, she still had recurrent intermittent vaginal bleeding after the operation and eventually had to undergo hysterectomy. Case 2 was a postmenopausal woman. The preoperative diagnosis was clear based on clinical characteristics, color Doppler ultrasound, enhanced CT and MRI, and hysterectomy was performed directly.