Ramanan Sangeeta, Chapman-Wardy Jude, Watson Roy
Lyell McEwin Hospital, Adelaide, SA 5112, Australia.
Modbury Hospital, Adelaide, SA 5092, Australia.
Case Rep Obstet Gynecol. 2016;2016:4169565. doi: 10.1155/2016/4169565. Epub 2016 Aug 14.
A 43-year-old woman presented with severe anaemia secondary to menorrhagia. Pelvic ultrasound showed a large intramural posterior fundal fibroid. Hysteroscopy showed the fibroid distorting the endometrial cavity, precluding Mirena® device insertion. As she was initially hesitant to have a hysterectomy, medical management with the oral contraceptive pill (OCP) and tranexamic acid was instituted, with good effect. Months later, after a long road trip, she presented with left leg swelling, and a Doppler ultrasound confirmed an extensive deep vein thrombosis (DVT). She was commenced on warfarin for anticoagulation but presented again with menorrhagia precipitated by overanticoagulation. After initial stabilization with multiple blood transfusions and reversal of anticoagulation, the warfarin was ceased in favour of enoxaparin and she underwent inferior vena cava (IVC) filter insertion prior to a total abdominal hysterectomy. Mass effect from large uterine fibroids can cause venous thromboembolism (VTE). A duplex ultrasound of the lower limbs if a woman presents with a large fibroid could identify asymptomatic DVTs in such women. A prehysterectomy IVC filter would then reduce their risk of postoperative pulmonary embolism. Medical management of menorrhagia with procoagulants should be avoided for management of menorrhagia in such women given their higher risk of developing VTE.
一名43岁女性因月经过多继发严重贫血就诊。盆腔超声显示子宫后壁有一个大的肌壁间肌瘤。宫腔镜检查显示肌瘤使子宫内膜腔变形，无法插入曼月乐®节育器。由于她最初对子宫切除术犹豫不决，因此开始采用口服避孕药（OCP）和氨甲环酸进行药物治疗，效果良好。数月后，在一次长途旅行后，她出现左腿肿胀，多普勒超声证实有广泛的深静脉血栓形成（DVT）。她开始使用华法林进行抗凝治疗，但又因抗凝过度导致月经过多再次就诊。在多次输血初步稳定病情并逆转抗凝作用后，停用华法林改用依诺肝素，并且在全腹子宫切除术前行下腔静脉（IVC）滤器置入术。巨大子宫肌瘤的占位效应可导致静脉血栓栓塞（VTE）。如果女性患有巨大肌瘤，对其下肢进行双功超声检查可发现无症状的DVT。子宫切除术前置入IVC滤器可降低她们术后发生肺栓塞的风险。鉴于此类女性发生VTE的风险较高，应避免使用促凝血剂对其月经过多进行药物治疗。
