Kontos Stylianos, Politis Vasilios, Fokitis Ioannis, Lefakis Georgios, Koritsiadis Georgios, Simaioforidis Vasileios, Kachrilas Stefanos, Chatziplis Evangelos, Koritsiadis Sotirios
Department of Urology, General Hospital of Nikea, 3 D, Mantouvalou St,, Nikea, 18454, Piraeus, Greece.
Cases J. 2008 Oct 17;1(1):245. doi: 10.1186/1757-1626-1-245.
Rapture of a renal angiomyolipoma and massive retroperitoneal hemorrhage, during pregnancy is rare and occasionally fatal. The association of this complication with pregnancy has been reported sporadically in the literature.
We report a case of a 28 years old woman, in 33 week of her first pregnancy who came to our hospital complaining of abdominal pain in the right hemiabdomen, associated with nausea and vomiting. The ultrasound and MRI (Magnetic resonance imaging) scan showed a 7 x 7 x 5 cm mass suggestive of angiomyolipoma in the right kidney, with evidence of retroperitoneal bleeding right perirenal and intrarenal haematoma. Given the size of the tumor, presence of symptoms and hemodynamic instability of the patient right nephrectomy was performed, following emergency caesarean delivery. The histological study of the resected mass revealed the presence of angiomyolipoma.
In conclusion, it seems that these tumours show a greater growth index in pregnant women. Angiomyolipoma with spontaneous bleeding during pregnancy is a dangerous condition that may cause mortality in the mother and fetus, but elective, simultaneous cesarean section and radical nephrectomy can be performed. We have also done a review of the literature focusing on its management and its relationship with pregnancy.
肾血管平滑肌脂肪瘤破裂并伴有大量腹膜后出血,在妊娠期较为罕见,偶尔会致命。文献中曾零星报道过这种并发症与妊娠的关联。
我们报告一例28岁初产妇,孕33周,因右侧半腹疼痛伴恶心、呕吐前来我院就诊。超声和磁共振成像(MRI)扫描显示右肾有一个7×7×5cm大小的肿块,提示为血管平滑肌脂肪瘤,伴有肾周和肾内血肿,存在腹膜后出血迹象。鉴于肿瘤大小、患者症状以及血流动力学不稳定情况,在紧急剖宫产术后,对患者实施了右肾切除术。切除肿块的组织学研究显示存在血管平滑肌脂肪瘤。
总之,似乎这些肿瘤在孕妇中生长指数更高。妊娠期血管平滑肌脂肪瘤伴自发出血是一种危险情况,可能导致母婴死亡,但可进行选择性的同期剖宫产和根治性肾切除术。我们还针对其治疗及其与妊娠的关系进行了文献综述。