Yokoe Takuya, Kita Masato, Fukuda Hisato, Butsuhara Yusuke, Sumi Genichiro, Okada Hidetaka
Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Sin-machi, Hirakata, Osaka, 573-1191, Japan.
Ann Med Surg (Lond). 2021 Nov 4;71:103025. doi: 10.1016/j.amsu.2021.103025. eCollection 2021 Nov.
and importance Postpartum retroperitoneal hematoma is a birth canal injury that is difficult to diagnose because of its invisibility. Secondary infections of these hematomas are rare, and their diagnostic and management strategies have not been fully elucidated. We present two cases of postpartum retroperitoneal hematomas with infection, which were successfully treated with minimally invasive surgery.
Case 1 was of a 2X-year-old woman who presented with complaints of fever; a provisional diagnosis of chorioamnionitis and -induced sepsis was made. Case 2 was of a 3X-year-old woman who underwent uterine artery embolization and manual removal of the placenta for suspected placenta accreta. Both cases were diagnosed with adnexal hematomas, and antibiotic therapy failed in both patients. Therefore, we performed exploratory laparoscopy and made a diagnosis of retroperitoneal hematomas with infection; laparoscopic drainage resulted in rapid resolution of the clinical symptoms and abnormal blood test results.
Once an abscess develops, antibiotic treatment has a limited effect, and surgical drainage should be performed. Management of retroperitoneal hematomas is difficult, especially when complicated by an infection.
Minimally invasive procedures involving laparoscopy could be beneficial for the management of postpartum retroperitoneal hematomas complicated by an infection.
产后腹膜后血肿是一种因不可见而难以诊断的产道损伤。这些血肿的继发感染罕见，其诊断和管理策略尚未完全阐明。我们报告两例产后腹膜后血肿合并感染的病例，均通过微创手术成功治疗。
病例1为一名2X岁女性，主诉发热；初步诊断为绒毛膜羊膜炎及感染性脓毒症。病例2为一名3X岁女性，因疑似胎盘植入接受子宫动脉栓塞及人工剥离胎盘术。两例均诊断为附件血肿，且抗生素治疗均无效。因此，我们进行了腹腔镜探查，诊断为腹膜后血肿合并感染；腹腔镜引流使临床症状和异常血液检查结果迅速缓解。
一旦形成脓肿，抗生素治疗效果有限，应进行手术引流。腹膜后血肿的管理困难，尤其是合并感染时。
涉及腹腔镜的微创手术可能有利于治疗合并感染的产后腹膜后血肿。
