Asian Journal of Medical Research and Case Reports

Background: Gestational trophoblastic disease (GTD) represents a spectrum of disorders arising from abnormal trophoblastic proliferation. Although GTD is relatively uncommon, it is clinically significant due to its potential for aggressive invasion, distant metastasis, and systemic complications. Arteriovenous malformations (AVMs) of the pelvis, particularly those involving the internal iliac arteries, are exceedingly rare vascular anomalies. Pelvic congestion syndrome (PCS) is another under-recognised condition characterised by chronic pelvic pain due to venous insufficiency. The coexistence of GTD with bilateral internal iliac AVMs has not been previously documented.

Case Presentation: We report the case of a 30-year-old female, gravida 2 para 1, who presented with four months of amenorrhoea and pelvic pain. On admission, she was conscious, oriented, and haemodynamically stable. Pelvic angiography revealed bilateral internal iliac artery AVMs, more pronounced on the left side. Laboratory evaluation showed mild anaemia (Hb 11.8 g/dL), normal ejection fraction (60%), and non-reactive serology. β-hCG and CBC were ordered for confirmation of GTD.

Management and Outcome: The patient was stabilised, and embolisation of the AVM was planned. She was discharged with antibiotics, analgesics, and a proton pump inhibitor. At discharge, her vital signs were stable, and she was advised to follow up with cardiology after one week. She was instructed to seek urgent care if she developed chest pain, shortness of breath, or gum bleeding.

Conclusion: This case illustrates a rare and previously unreported association between GTD and bilateral internal iliac artery AVMs. It highlights the importance of considering vascular malformations in patients with GTD who present with atypical pelvic symptoms. Early recognition, angiographic evaluation, and multidisciplinary management are crucial to prevent potentially life-threatening complications.