Lu Gao Jennifer, Lortie Karine, Singh Sukhbir Sony
School of Medicine, Queen's University, Kingston ON.
Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa ON.
J Obstet Gynaecol Can. 2010 Dec;32(12):1172-1175. doi: 10.1016/S1701-2163(16)34742-9.
Spontaneous hemoperitoneum in pregnancy or the postpartum period is an uncommon but potentially life-threatening complication.
A 29-year-old woman presented with severe abdominal pain, decreased consciousness, and a reduced hemoglobin level three days after an uneventful spontaneous vaginal delivery. Initial ultrasound and CT imaging showed significant hemoperitoneum with no identifiable cause. Laparoscopic surgery was performed, during which bleeding from the left uterine artery was identified and resolved with laparoscopic internal iliac artery ligation. Concomitant cul-de-sac obliteration and adhesions secondary to decidualized endometriosis were found.
Decidualized endometriosis is a possible etiologic factor in spontaneous hemoperitoneum. Prompt diagnosis and treatment are critical for improving outcomes. When surgical intervention is indicated, a laparoscopic approach should be considered because of its minimally invasive nature and shorter recovery time.
妊娠或产后自发性腹腔积血是一种罕见但可能危及生命的并发症。
一名29岁女性在顺产过程顺利三天后出现严重腹痛、意识减退和血红蛋白水平降低。最初的超声和CT成像显示有大量腹腔积血，但未发现明确病因。进行了腹腔镜手术，术中发现左侧子宫动脉出血，并通过腹腔镜髂内动脉结扎术得以解决。同时发现了因蜕膜化子宫内膜异位症导致的直肠子宫陷凹闭塞和粘连。
蜕膜化子宫内膜异位症是自发性腹腔积血的一个可能病因。及时诊断和治疗对于改善预后至关重要。当需要手术干预时，应考虑采用腹腔镜方法，因为其具有微创性和较短的恢复时间。
