Habek D, Bauman R, Rukavina Kralj L, Hafner T, Turudic T, Vujisic S
University Ob/Gyn Department, Croatian Catholic University Zagreb, Clinical Hospital Sveti Duh Zagreb, Zagreb, Croatia.
Clinical Hospital Sveti Duh Zagreb, Zagreb, Croatia.
Geburtshilfe Frauenheilkd. 2016 Dec;76(12):1345-1349. doi: 10.1055/s-0042-116492.
A 32-year-old woman with tubal factor infertility due to bilateral laparoscopic salpingectomy conceived twins with in vitro fertilization (IVF). She developed moderate ovarian hyperstimulation syndrome which was treated with anticoagulant therapy. The subsequent course of the twin pregnancy was normal until the 17th week of gestation when she presented to hospital because of a sharp pain in the right lower abdomen which ceased after admission. Except for a single incident of vomiting, patient had no other subjective symptoms. The clinical examination showed tenderness of the lower right abdominal segment on palpation. The surgeon and the urologist found no signs of an acute surgical or urologic condition, and laboratory findings were within normal reference ranges for pregnant women. Two days after admission the pain reappeared; it was now much stronger and colic-like. The pain was initially located supraumbilically but subsequently spread diffusely across the lower abdomen. Abdominal guarding was present and laboratory findings showed an increase in inflammatory parameters. An enlarged and edematous right ovary was found on transvaginal ultrasound. Exploratory laparotomy via a vertical midline abdominal transection revealed a torqued necrotic right ovary with elements of inflammation and inflammatory adhesions involving the entire pelvis. The patient underwent right-sided ovariectomy and adhesiolysis. Recovered was normal and the patient was delivered of healthy twins in the 37th week of gestation.
一名32岁因双侧腹腔镜输卵管切除术导致输卵管因素不孕的女性通过体外受精（IVF）怀上了双胞胎。她出现了中度卵巢过度刺激综合征，并接受了抗凝治疗。双胞胎妊娠的后续过程正常，直到妊娠第17周，她因右下腹部剧痛入院，入院后疼痛停止。除了一次呕吐外，患者没有其他主观症状。临床检查发现右下腹部触诊时有压痛。外科医生和泌尿科医生未发现急性外科或泌尿系统疾病的迹象，实验室检查结果在孕妇正常参考范围内。入院两天后疼痛再次出现；现在疼痛剧烈得多，呈绞痛样。疼痛最初位于脐上，但随后扩散至整个下腹部。出现了腹部压痛，实验室检查结果显示炎症参数升高。经阴道超声检查发现右侧卵巢肿大且水肿。通过腹部正中垂直切口进行的剖腹探查显示，右侧卵巢扭转坏死，伴有炎症成分以及累及整个骨盆的炎性粘连。患者接受了右侧卵巢切除术和粘连松解术。恢复正常，患者在妊娠第37周分娩出健康双胞胎。
