Kassegne I, Kolani K, Tchangai B, Kanassoua K, Adabra K, Alassani F, Amavi A K, Dosseh E D J
Service de Chirurgie Générale et Viscérale, Centre Hospitalier Universitaire Sylvanus Olympio, BP: 57 Lomé, Togo.
Service de Gynécologie et Obstétrique, Clinique Biasa, BP: 2160 Lomé, Togo.
J Surg Case Rep. 2017 Jul 7;2017(7):rjx127. doi: 10.1093/jscr/rjx127. eCollection 2017 Jul.
Massive hemoperitoneum from spontaneous bleeding of uterine myoma is an extremely rare condition, that needs urgent surgical exploration. We report a 40-year-old woman, admitted for acute onset of abdominal pain. Physical examination revealed hypovolemic shock. The hemoglobin level was of 5 g/dL. Ultrasonography revealed hemoperitoneum. Emergency surgical exploration was planned. There was hemoperitoneum of 3 L, uterine myomas with multiple subserous myomas, bleeding from superficial ruptured varice overlying the most largest subserous myoma, which measured 15 cm. Glove adapted as a tourniquet, was applied at the base of the uterus, and myomectomies were performed with removal of around twenty myomas. The postoperative course was uneventful. Myomectomies can be safely and effectively performed by using a tourniquet, for massive hemoperitoneum with precarious hemodynamic status due to subserous myoma bleeding, despite the number and the size of myomas.
子宫肌瘤自发性出血导致的大量腹腔积血是一种极为罕见的情况，需要紧急进行手术探查。我们报告一名40岁女性，因突发腹痛入院。体格检查发现低血容量性休克。血红蛋白水平为5 g/dL。超声检查显示腹腔积血。计划进行急诊手术探查。腹腔积血达3 L，有子宫肌瘤，多个浆膜下肌瘤，最大的一个浆膜下肌瘤大小为15 cm，其表面破裂的静脉曲张出血。将手套改装成止血带，应用于子宫底部，进行肌瘤切除术，切除了约二十个肌瘤。术后过程顺利。对于因浆膜下肌瘤出血导致血流动力学不稳定的大量腹腔积血情况，无论肌瘤的数量和大小如何，使用止血带都可以安全有效地进行肌瘤切除术。
