Djusad Suskhan, Dilmy Mohammad Adya Firmansha, Suastika Arresta Vitasatria, Fadhly Raden Muhammad Ali, Purwosunu Yuditiya
Department of Obstetrics and Gynecology, University of Indonesia, Jakarta, Indonesia.
Department of Obstetrics and Gynecology, University of Indonesia, Jakarta, Indonesia.
Int J Surg Case Rep. 2021 Nov;88:106489. doi: 10.1016/j.ijscr.2021.106489. Epub 2021 Oct 6.
Placenta accreta spectrum (PAS) is a state of abnormal attachment of the placenta, including placenta accreta, placenta increta, and placenta percreta. This condition can be life-threatening due to the placenta cannot spontaneously separated, resulting in continuous bleeding. Cesarean section followed by hysterectomy is one of the treatment options for PAS. There was a great liability for urinary tract injuries during the operation of PAS patient.
We present the case of ureter injury during subtotal hysterectomy in patient with PAS. A 30-years-old female patient was diagnosed with recurrent antepartum hemorrhage due to placenta previa accreta spectrum on G2P1 33 weeks of gestational age, singleton live breech presentation, previous c-section 1×. After uterine transverse incision, the baby was delivered. We decided to perform subtotal hysterectomy. There was severe adhesion. On the exploration after subtotal hysterectomy was performed, we found ruptured of the right ureter.
Hysterectomy peripartum is one of the treatment of PAS, either to prevent or to control postpartum hemorrhage. In pregnant women with morbid placental adherence, there was a great liability for urinary tract injuries. Distal ureters are the most commonly injured while hysterectomy. Injuries to the ureters in this patient occurred due to severe adhesions and unclear visual organ.
Although it is rare, ureter injury may occur during subtotal hysterectomy in patient with placenta accreta spectrum. To prevent that condition, inserting ureter stent can be perform before the operation. Multidisciplinary approach is carried out so that patient outcomes are good.
胎盘植入谱系疾病（PAS）是胎盘异常附着的一种状态，包括胎盘粘连、胎盘植入和穿透性胎盘植入。由于胎盘无法自然剥离，这种情况可能会危及生命，导致持续出血。剖宫产加子宫切除术是PAS的治疗选择之一。在PAS患者手术过程中，尿路损伤的风险很大。
我们报告一例PAS患者在次全子宫切除术中发生输尿管损伤的病例。一名30岁女性患者，孕2产1，孕33周，单胎臀位，既往剖宫产1次，因前置胎盘植入谱系疾病诊断为复发性产前出血。子宫横切口后，娩出胎儿。我们决定行次全子宫切除术。粘连严重。次全子宫切除术后探查发现右侧输尿管破裂。
围产期子宫切除术是PAS的治疗方法之一，用于预防或控制产后出血。在患有病态胎盘粘连的孕妇中，尿路损伤的风险很大。子宫切除术中最常损伤的是输尿管远端。该患者输尿管损伤是由于严重粘连和手术视野不清所致。
虽然罕见，但胎盘植入谱系疾病患者在次全子宫切除术中可能发生输尿管损伤。为预防这种情况，可在手术前放置输尿管支架。采取多学科方法可使患者获得良好预后。
