Temporary balloon occlusion of the common iliac arteries during hysterectomy for giant cervical fibroid

Surgical treatment of giant uterine fibroids with cervical localization represents one of the most challenging tasks in operative gynecology. The main difficulties are associated with distorted pelvic anatomy, limited space for manipulations, and a high risk of massive intraoperative bleeding, which necessitates the use of modern blood loss control techniques. Among these approaches, temporary endovascular balloon occlusion of the major pelvic vessels has proven to be a highly effective technique for minimizing hemorrhagic risk and ensuring the safety of radical surgery. This article presents a clinical case describing successful treatment of a 56-year-old woman with a giant uterine fibroid of a 20-week gestational size, cervical localization of the lesion, and severe comorbidities. The patient’s medical history was complicated by an episode of massive uterine bleeding in February 2024 that required emergency uterine artery embolization. Considering the patient’s age, fibroid size, complex localization, and comorbidity burden, a two-stage treatment strategy was chosen. During the first stage, preoperative preparation with a gonadotropin-releasing hormone agonist was carried out for three months to reduce fibroid volume. At the second stage, panhysterectomy was performed with prior temporary balloon occlusion of the common iliac arteries. With temporary vascular occlusion, hysterectomy with bilateral adnexectomy was successfully completed. A critical outcome was minimal intraoperative blood loss of only 200 mL, which did not require blood transfusion. The arterial occlusion lasted 40 minutes, which prevented ischemic complications. This clinical case clearly demonstrates the effectiveness of temporary balloon occlusion of the major pelvic vessels as a key method for preventing massive intraoperative blood loss during hysterectomy for giant uterine fibroids with complex localization. The technique appears promising and may be considered a standard of care in similar clinical situations.