Percutaneous ethanol sclerosis with balloon inflow occlusion for persistent bleeding associated with enhanced myometrial vascularity

Enhanced myometrial vascularity (EMV) is a common postpartum sonographic finding of increased myometrial vascularity that rarely causes persistent, hemodynamically significant vaginal bleeding. We report a case of a 30-year-old female with persistent vaginal bleeding following childbirth associated with EMV that was refractory to conservative management. The patient underwent successful percutaneous ethanol sclerotherapy with balloon inflow occlusion and adjunct gelfoam embolization. She had resolution of bleeding, normalization of uterine vascularity, and no recurrence at 1-month follow-up. Ethanol sclerotherapy is associated with systemic and local complications, which may be reduced through balloon inflow occlusion and direct percutaneous puncture to limit off-target ethanol spread. Balloon-assisted ethanol sclerotherapy is a promising, definitive, fertility-preserving treatment for persistent bleeding associated with EMV.