A very rare case of delayed catastrophic arterial bleed post-vaginoplasty

Abstract

The gold standard for male to female genital reconstruction in the UK is vaginoplasty with penile and/or scrotal skin for neovagina formation. We present a rare case of a major haemorrhage in a 46-year-old patient, 26 days post-vaginoplasty. An urgent computed tomography scan identified a large retrovesical collection, with high-density contents in keeping with recent haemorrhage, containing a 6mm pseudoaneurysm within the right lateral wall. Following resuscitation, the patient was urgently treated with successful embolization of the feeding artery (branch of the prostatic artery), with pushable coils. We highlight the importance of expedient, life-saving management in a rare post-operative complication. Keywords: Vaginoplasty, Pseudoaneurysm, Arterial embolization, Genital reconstruction, Sex reassignment surgery, Gender reassignment surgery