Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. The common causes of primary PPH include uterine atony, abnormal placentation, retained placenta, and birth canal injury. The inferior mesenteric artery (IMA) arises from the aorta and is the main artery to supply the descending and sigmoid colon, as well as the rectum. We present a case of immediate, severe uterine bleeding after a normal vaginal delivery; angiography determined that hemorrhage originated from the IMA, and there were no anastomoses between the IMA and other pelvic arteries. The patient was successfully managed by selective embolization of a distal branch of the IMA. Our case report presents a new and interesting variation of pelvic vascular anatomy; moreover, it is the first report to present a case of postpartum uterine bleeding originating from the IMA.

1.
World Health Organization: Recommendations for the Prevention of Postpartum Hemorrhage (summary of results from a WHO technical consultation, October 2006). Geneva, WHO, 2007.
2.
Geller SE, Adams MG, Kelly PJ, Kodkany BS, Derman RJ: Postpartum hemorrhage in resource-poor settings. Int J Gynaecol Obstet 2006;92:202-211.
3.
Ojengbede OA, Morhason-Bello IO, Galadanci H, Meyer C, Nsima D, Camlin C, Butrick E, Miller S: Assessing the role of the non-pneumatic anti-shock garment in reducing mortality from postpartum hemorrhage in Nigeria. Gynecol Obstet Invest 2011;71:66-72.
4.
World Health Organization: The World Health Report 2005 - Make Every Mother and Child Count. Geneva, WHO, 2005.
5.
de Lange NM, Lancé MD, de Groot R, Beckers EA, Henskens YM, Scheepers HC: Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv 2012;67:426-435.
6.
Clark SL, Yeh SY, Phelan JP, Bruce S, Paul RH: Emergency hysterectomy for obstetric hemorrhage. Obstet Gynecol 1984;64:376-380.
7.
Paglia MJ, Grotegut CA, Johnson LN, Thames B, James AH: Body mass index and severe postpartum hemorrhage. Gynecol Obstet Invest 2012;73:70-74.
8.
Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller FJ Jr: Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol 1979;54:361-365.
9.
Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, Merland JJ: Arterial embolisation to treat uterine myomata. Lancet 1995;346:671-672.
10.
Shao MJ, Hu MX, Xu XJ, Zhang L, Hu M: Management of caesarean scar pregnancies using an intrauterine or abdominal approach based on the myometrial thickness between the gestational mass and the bladder wall. Gynecol Obstet Invest 2013;76:151-157.
11.
Shen L, Tan A, Zhu H, Guo C, Liu D, Huang W: Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy. Am J Obstet Gynecol 2012;207:386.e1-e6.
12.
Zhang B, Jiang ZB, Huang MS, Guan SH, Zhu KS, Qian JS, Zhou B, Li MA, Shan H: Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: results of a case series and review of the literature. J Vasc Interv Radiol 2012;23:1582-1588.
13.
Clemente CD: Clemente's anatomy dissector: guides to individual dissections in human anatomy with brief relevant clinical notes (applicable for most curricula), ed 3. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins Health, 2010.
14.
Smoger DL, Kancherla V, Shlansky-Goldberg RD: Uterine fundal blood supply from an aberrant left ovarian artery originating from the inferior mesenteric artery: implications for uterine artery embolization. J Vasc Interv Radiol 2010;21:941-944.
15.
Dixon S, Tapping CR, Chuah PS, Bratby M, Uberoi R, Anthony S: Successful fibroid embolization of pelvic and inferior mesenteric artery collaterals after previous uterine artery embolization. Acta Radiol 2012;53:292-295.
16.
Horton AW, Patel U, Belli AM: An unusual arterial supply to the uterus. A case report and review of anatomy-implications for uterine artery embolization. Clin Radiol 2010;65:1038-1042.
17.
McLucas B: Extra-gonadal collateral supply to uterine leiomyomata: a case report. Minim Invasive Ther Allied Technol 2009;18:103-105.
18.
Ayoub SF: Arterial supply to the human rectum. Acta Anat (Basel) 1978;100:317-327.
19.
Axelrod DJ, Lookstein RA, Guller J, Nowakowski FS, Ellozy S, Carroccio A, Teodorescu V, Marin ML, Mitty HA: Inferior mesenteric artery embolization before endovascular aneurysm repair: technique and initial results. J Vasc Interv Radiol 2004;15:1263-1267.
20.
Kim JW, Kim YH, Kim CH, Cho MK, Kang WD, Kim SM, Yim NY, Song TB: Uterine artery pseudoaneurysm manifesting as delayed postpartum hemorrhage after precipitous delivery: three case reports. Gynecol Obstet Invest 2014;78:136-140.
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