Sinha M, Kaur R, Gupta R, Rani R, Aggarwal A
Department of Obstetrics & Gynaecology Kasturba Hospital, Delhi, India.
West Virginia University- Charleston Division Charleston Area Medical Center Charleston, West Virginia, USA.
Kathmandu Univ Med J (KUMJ). 2014 Oct-Dec;12(48):288-91. doi: 10.3126/kumj.v12i4.13736.
Gestational trophoblastic neoplasms (GTN) are proliferative degenerative disorders of placental elements and include complete or partial mole (90%), invasivemole (5-8%), choriocarcinoma (1-2%) and placental site tumor (1-2%). Chorioadenoma destruens is a trophoblastic tumor, characterized by myometrial invasion through direct extension or via venous channels. We present a case of invasive mole eroding uterus and uterine vasculature, causing sudden rupture of uterus with massive haemoperitoneum mimicking ectopic pregnancy. A 20 year old G1P0 at 6 weeks gestation presented in Casualty of Kasturba Hospital complaining of severe acute onset lower abdominal pain for one hour. Clinical examination revealed shock. Sonography suggested ectopic pregnancy and immediate exploratory laparotomy was decided. On laparotomy, 2000cc of haemoperitoneum was noted. Grape like vesicles protruding through fundal perforation with profuse active bleeding was seen. Bleeding persisted despite evacuation. Step wise uterine devascularisation failed to achieve haemostasis. Total abdominal hysterectomy was performed as a life saving measure.
妊娠滋养细胞肿瘤（GTN）是胎盘组织的增殖性退行性疾病，包括完全性或部分性葡萄胎（90%）、侵蚀性葡萄胎（5 - 8%）、绒毛膜癌（1 - 2%）和胎盘部位肿瘤（1 - 2%）。破坏性绒毛膜腺瘤是一种滋养细胞肿瘤，其特征是通过直接蔓延或经静脉通道侵犯子宫肌层。我们报告一例侵蚀性葡萄胎侵蚀子宫及子宫血管，导致子宫突然破裂并伴有大量腹腔内出血，酷似宫外孕。一名20岁、孕1产0、妊娠6周的妇女因严重急性下腹痛1小时就诊于卡斯图尔巴医院急诊科。临床检查发现休克。超声检查提示宫外孕，遂决定立即行剖腹探查术。剖腹探查时，发现腹腔内有2000cc积血。可见葡萄样水泡从子宫底部穿孔处突出，伴有大量活动性出血。尽管进行了清宫，出血仍持续。逐步进行子宫血管离断术未能止血。作为挽救生命的措施，行全腹子宫切除术。
