Kuwata Tomoyuki, Matsubara Shigeki, Usui Rie, Uchida Shin-Ichiro, Sata Naohiro, Suzuki Mitsuaki
Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
J Med Case Rep. 2011 Oct 23;5:523. doi: 10.1186/1752-1947-5-523.
Uterine rupture is a life-threatening condition both to mothers and fetuses. Its early diagnosis and treatment may save their lives. Previous myomectomy is a high risk factor for uterine rupture. Intestinal adhesion due to previous myomectomy may also prevent early diagnosis of uterine rupture.
A 38-year-old primiparous non-laboring Japanese woman with a history of myomectomy was admitted in her 34th week due to lower abdominal pain. Although the pain was slight and her vital signs were stable, computed tomography revealed massive fluid collection in her abdominal cavity, which led us to perform a laparotomy. Uterine rupture had occurred at the site of the previous myomectomy; however, the small intestine was adhered tightly to the rupture, thus masking it. The baby was delivered through a low uterine segment transverse incision. The ruptured uterine wall was reconstructed.
Intestinal adhesion due to a prior myomectomy occluded a uterine rupture, possibly masking its symptoms and signs, which may have prevented early diagnosis.
子宫破裂对母亲和胎儿均构成危及生命的状况。其早期诊断和治疗可挽救他们的生命。既往子宫肌瘤切除术是子宫破裂的高危因素。既往子宫肌瘤切除术导致的肠粘连也可能妨碍子宫破裂的早期诊断。
一名38岁初产未临产的日本女性，有子宫肌瘤切除病史，因下腹痛于孕34周入院。尽管疼痛轻微且生命体征稳定，但计算机断层扫描显示其腹腔内有大量积液，这促使我们进行了剖腹探查术。子宫破裂发生在既往子宫肌瘤切除部位；然而，小肠紧密粘连于破裂处，从而掩盖了破裂情况。通过子宫下段横切口娩出婴儿。对破裂的子宫壁进行了重建。
既往子宫肌瘤切除术导致的肠粘连封堵了子宫破裂，可能掩盖了其症状和体征，这可能妨碍了早期诊断。
