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疑似遗传性出血性毛细血管扩张症患者经阴道取卵术后迟发性卵巢出血

Late-Onset Ovarian Bleeding After Transvaginal Oocyte Retrieval in a Patient With Suspected Hereditary Hemorrhagic Telangiectasia.

作者信息

Tamura Kohei, Takahashi Hironori, Tatsuya Suzuki, Ohhashi Mai, Fujiwara Hiroyuki

机构信息

Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, JPN.

Reproductive Medicine Center, Dokkyo Medical University Hospital, Mibu, JPN.

出版信息

Cureus. 2023 Sep 21;15(9):e45657. doi: 10.7759/cureus.45657. eCollection 2023 Sep.

Abstract

Assisted reproductive technology (ART) requires transvaginal oocyte retrieval (TVOR), and ovarian bleeding after TVOR rarely occurs. We present a case of a 37-year-old woman (0-gravida) who was diagnosed with possible hemorrhagic telangiectasia (HHT) and had a history of three laparotomies for ovarian bleeding and an inclusion cyst adjacent to the right ovary after the third operation. HHT is a hereditary disease characterized by spontaneous hemorrhage of some organs, such as the nose, brain, lungs, gastrointestinal tract, and liver. She desired ART after fertility treatment and then had abdominal pain with ovarian swelling five days after TVOR. Moreover, both the right ovary and inclusion cyst were gradually swollen with hematoma. Finally, abdominal pain and the hemoglobin level deteriorated, necessitating an emergency surgery on the eighth day. We notify reproductive physicians that patients with HHT may readily develop ovarian bleeding with or without inclusion cysts after TVOR, although inclusion cysts may also be associated with late-onset bleeding.

摘要

辅助生殖技术(ART)需要经阴道取卵(TVOR),TVOR后卵巢出血很少发生。我们报告一例37岁未孕女性,被诊断为可能患有遗传性出血性毛细血管扩张症(HHT),有三次因卵巢出血行剖腹手术史,第三次手术后右侧卵巢旁有一个包涵囊肿。HHT是一种遗传性疾病,其特征是某些器官如鼻、脑、肺、胃肠道和肝脏发生自发性出血。她在接受生育治疗后希望进行ART,TVOR五天后出现腹痛伴卵巢肿大。此外,右侧卵巢和包涵囊肿均逐渐肿大并伴有血肿。最后,腹痛加剧,血红蛋白水平下降,在第八天需要进行急诊手术。我们提醒生殖科医生,HHT患者在TVOR后无论有无包涵囊肿都可能容易发生卵巢出血,尽管包涵囊肿也可能与迟发性出血有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c7fd/10589731/3ce38619cffa/cureus-0015-00000045657-i01.jpg

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