Multiple Congenital Arteriovenous Malformations with Involvement of the Vagina and Profuse Hemorrhage from Vaginal Ulcer

Congenital arteriovenous malformation (AVM) of the female pelvis is a rare but potentially life-threatening condition. An unusual presentation of AVM involving the vagina, abdominal wall, spleen and thigh, with profuse hemorrhage from a vaginal ulcer is described. Doppler, real time ultrasound and computerized tomography were useful in confirmation and delineation of the extensive AVM in this case. Angiography and embolization were thought risky and possibly unnecessary. Bleeding stopped with bed rest and vaginal packing with gauze soaked in 3% hypertonic saline. The ulcer healed after 3 months with conservative management. The risk of future problems was explained to the patient and follow-up was advised. Undertreatment of AVM may be preferable to overtreatment, and the aim should be 'control' rather than 'cure'.