Major venous hemorrhagic complication during transvaginal cystocele repair using the transobturator approach.

BACKGROUND: New approaches to pelvic organ prolapse have been evolving rapidly with few reports on safety and efficacy. This case describes the management of a severe intraoperative venous hemorrhage when performing this minimally invasive surgery. CASE: A postmenopausal woman experienced a life-threatening hemorrhagic complication during transvaginal cystocele repair using a transobturator approach procedure. The bleeding appeared after the posterior left needle insertion. Immediate imaging revealed that bleeding came from a terminal anterior branch of the left internal hypogastric vein. Embolization of the left hypogastric artery partially reduced the hemorrhage. Local packing was the most efficient hemostatic technique. Pelvic varicose veins were the major risk factor found in this case. CONCLUSION: Although the transobturator technique is considered minimally invasive surgery, morbidity can be severe and require specific management.