Lee Matthew, Yu Lissa
California Northstate University College of Medicine, USA.
Kaiser Permanente Fresno, USA.
Case Rep Womens Health. 2021 Feb 20;30:e00301. doi: 10.1016/j.crwh.2021.e00301. eCollection 2021 Apr.
Of women diagnosed with endometriosis, 3.8-37% have bowel endometriosis. The cecum is the least common site for endometriotic implants affecting the bowel, accounting for only 3.6-6% of cases. We present a case of intrauterine fetal demise at term in which the patient was found to have gastrointestinal bleeding caused by endometriosis of the cecum.
A 35-year-old woman, gravida 4, para 1, at 37 weeks and 3 days of gestation, without a known history of endometriosis but with two prior miscarriages, presented with severe anemia and intrauterine fetal demise. During delivery, melanotic stool was noted. Colonoscopic biopsy noted the source of bleeding to be a 2 cm endometriotic implant in the patient's cecum. Suppression therapy was started. Postpartum, the patient underwent laparoscopic cecectomy and pathology confirmed the diagnosis of endometriosis.
Hemorrhage from endometriotic implants may occur during pregnancy due to changes in the hormonal milieu. Bowel endometriosis may increase the risk of maternal hemorrhage during pregnancy, thereby increasing the risk of unfavorable pregnancy outcomes, including intrauterine fetal demise.
在被诊断为子宫内膜异位症的女性中，3.8% - 37%患有肠道子宫内膜异位症。盲肠是受子宫内膜异位症影响的肠道中最不常见的部位，仅占病例的3.6% - 6%。我们报告一例足月宫内胎儿死亡病例，该患者被发现因盲肠子宫内膜异位症导致胃肠道出血。
一名35岁女性，孕4产1，妊娠37周零3天，既往无子宫内膜异位症病史，但有两次流产史，因严重贫血和宫内胎儿死亡就诊。分娩期间，发现有黑色粪便。结肠镜活检显示出血源为患者盲肠内一个2厘米的子宫内膜异位植入物。开始进行抑制治疗。产后，患者接受了腹腔镜盲肠切除术，病理证实为子宫内膜异位症。
由于激素环境的变化，孕期子宫内膜异位植入物可能会出血。肠道子宫内膜异位症可能会增加孕期母体出血的风险，从而增加不良妊娠结局的风险，包括宫内胎儿死亡。
