Medical Treatment of a Uterine Arteriovenous Malformation

EDITORIAL COMMENT: A certain degree of scepticism in medicine is to be encouraged if for no other reason than to promote thought about aetiology and different methods of treatment. We have published 3 previous case reports in our journal on the successful management of so called arteriovenous malformations of the uterus (A, B, C). Since the new technology has become available that allows precise diagnosis of arteriovenous fistulas there have been numerous case reports on such lesions in the uterus in the gynaecological literature. One wonders what happened to these patients previously. Surely many must have had curettage performed for menorrhagia and yet how often was it necessary to perform hysterectomy for uncontrollable uterine haemorrhage after such a procedure? The only patient the editor can remember treating who required an emergency hysterectomy for torrential haemorrhage following curettage was a 17-year-old woman with an unsuspected choriocarcinoma, who had a preoperative diagnosis of incomplete abortion (D). From the point of view of aetiology, surely these lesions should be called arteriovenous fistulas rather than malformations because the patients often have had previous uterine surgery or complications that could have been causal. We accepted this case for publication because it suggests that trial of hormone therapy is a reasonable method of treatment in patients with uterine arteriovenous fistulas who have not got intractable haemorrhage and who wish to preserve their uterus.