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Chest X-ray after resuscitative endovascular balloon occlusion of the aorta (REBOA) inflation in a 40-year-old woman with uterine rupture. The REBOA catheter was placed in the aorta. After REBOA inflation at Zone 1 (arrowheads), spontaneous circulation returned, and the systolic blood pressure increased to 200 mmHg in response to adrenaline administration. After the balloon migrated to Zone 2 (arrows), it was returned to Zone 1 under ultrasonography (arrowheads).
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A 7F sheath was inserted through the left common femoral artery, and a REBOA catheter (Rescue Balloon ER; Tokai Medical Products) was placed and inflated above the diaphragm (Zone 1) (Figure 1). She received CPR for 44 min in total (Table 1, Figure S1).
Uterine rupture in a 40-year-old woman treated with a damage-control strategy of hysterectomy and resuscitative endovascular balloon occlusion of the aorta-assisted cardiopulmonary resuscitation. (A) Intraoperatively, the uterus was lacerated from the cervix to the uterine body (arrow). (B) Postoperative abdominal computed tomography. Gauze was packed in the abdomen and pelvis (arrows).
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We observed a laceration of the uterus from the anterior wall to the right cervix (Figure 2A). Pelvic gauze packing was used due to sustained oozing (Figure 2B) and the patient was transferred to the intensive care unit for open abdomen management. Computed tomography angiography revealed extravasation in the right rectus abdominis muscle, so we embolized the right inferior epigastric artery with gelatin sponges (Figure S2).