One of the cases had liver disease with resultant portal hypertension and three had known histories of total radical hysterectomy suggesting lack of uterine vascular network leading to increased venous pressure in the vaginal venous plexus
. Four of the patients made complete recoveries by 34 months following a variety of treatments including partial vaginectomy, transvaginal ligation, and tamponade followed byballoon-occluded retrograde obliteration, tamponade, and surgical hemostasis followed by TIPS, and TIPS was followed by liver transplantation .
The morbidly adherent placenta is a hypervascular organ; it recruits a host of blood vessels, largely from the vaginal arteries, superior vesical arteries, and vaginal venous plexus
. In most cases, this vascular remodeling exacerbates vascular patterns that are distorted to begin with as a result of the scarring process following previous uterine surgery.
(9) The exact mechanism is not known; however retrograde venous flow of tumor cells from left renal vein to the left ovarian vein and cervical and vaginal venous plexus
explains the spread of left sided RCC to uterus.