Kamil Hazem, Aboulkher Mhd Ghazi, Anbarji Abdullah, Martini Nafiza, Adwan Dema
Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic.
Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic.
Int J Surg Case Rep. 2024 May;118:109678. doi: 10.1016/j.ijscr.2024.109678. Epub 2024 Apr 23.
Uterine arteriovenous malformation (UAVM) can be present at birth or acquired later, often after trauma like cesarean delivery. It can cause severe vaginal bleeding but may have no symptoms. What makes our case special, other than being a rare condition, is the surgical technique used.
A 24-year-old woman came in with abdominal pain at 38 weeks pregnant. She had a cesarean delivery 13 months before. She had an uncomplicated repeat cesarean but bled heavily after from uterine atony. A 5 × 7 cm asymptomatic uterine AVM was found incidentally in the right uterine horn. After the transfusion, B-Lynch sutures were used to treat the atony and AVM. The patient recovered well after the sutures. Follow-up ultrasound showed the AVM got much smaller and no more bleeding.
While conventional approaches advocate hysterectomy or uterine artery embolization (UAE), our case, situated in a low-income setting, necessitated innovative strategies. With embolization unavailable, and surgery carrying inherent risks, the B-lynch Procedure emerged as a pragmatic choice.
Uterine AVM with no symptoms can happen after cesarean delivery. In low-resource settings, modified compression sutures can effectively treat heavy bleeding after delivery and shrink AVM size, avoiding hysterectomy.
子宫动静脉畸形（UAVM）可在出生时就存在，也可在之后获得，通常在剖宫产等创伤后出现。它可导致严重的阴道出血，但也可能没有症状。除了病情罕见外，我们这个病例的特别之处在于所采用的手术技术。
一名24岁女性在怀孕38周时因腹痛前来就诊。她在13个月前进行了剖宫产。此次她进行了一次顺利的再次剖宫产，但术后因子宫收缩乏力大量出血。偶然在子宫右角发现了一个5×7厘米无症状的子宫动静脉畸形。输血后，使用B-Lynch缝合术治疗子宫收缩乏力和动静脉畸形。缝合术后患者恢复良好。随访超声显示动静脉畸形明显变小且不再出血。
虽然传统方法主张进行子宫切除术或子宫动脉栓塞术（UAE），但我们这个病例处于低收入环境，需要创新策略。由于无法进行栓塞术，且手术存在固有风险，B-Lynch手术成为一种务实的选择。
剖宫产术后可能出现无症状的子宫动静脉畸形。在资源匮乏的环境中，改良压迫缝合术可有效治疗产后大出血并缩小动静脉畸形的大小，避免子宫切除术。
