Parviz Sara, Deldar Pasikhani Maryam, KHazardoost Soghra, Malek Mahrooz, Zamani Narges
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Int J Surg Case Rep. 2024 Jun;119:109741. doi: 10.1016/j.ijscr.2024.109741. Epub 2024 May 9.
Uterine rupture is a rare condition that typically occurs in a scarred uterus and can happen during late pregnancy, labor, or the early postpartum period. Since most cases are seen in patients with a history of cesarean surgery, the anterior lower uterine segment is the most affected area. Most patients present with acute symptoms that compromise the fetus and the mother in a life-threatening manner.
We present a case of uterine rupture with subacute symptoms occurring in the second trimester, which is extremely rare. The patient was a stable second-trimester multiparous woman with chronic abdominal pain, but without any signs of peritoneal bleeding or instability. No history of previous cesarean section was present, and she had recently undergone a non-complicated hysteroscopic polypectomy. Transabdominal and transvaginal ultrasounds were performed, revealing a significant full-thickness myometrial defect in the posterior uterine lower segment. This defect allowed the amniotic sac to protrude into the posterior cul-de-sac. No abdominopelvic hematoma was detected. These findings were confirmed in an urgent MRI, and the patient underwent a laparotomy during which a significant full-thickness defect was discovered at the posterior of the uterus. As it was impossible to continue the pregnancy, the fetus was surgically removed and then prepared using multiple layers.
The difference between our case and the previously reported one is in the aspect of gradual stable presentation and lacks of vaginal bleeding.
Previous hysteroscopy carries a risk for future pregnancy complications, such as uterine rupture.
子宫破裂是一种罕见病症，通常发生于瘢痕子宫，可在妊娠晚期、分娩期或产后早期出现。由于大多数病例见于有剖宫产手术史的患者，子宫下段前壁是最常受累部位。大多数患者表现为急性症状，以危及生命的方式影响胎儿和母亲。
我们报告一例妊娠中期出现亚急性症状的子宫破裂病例，极为罕见。患者是一名妊娠中期稳定的经产妇，有慢性腹痛，但无腹膜出血或不稳定迹象。既往无剖宫产史，近期接受了无并发症的宫腔镜下息肉切除术。经腹和经阴道超声检查显示子宫下段后壁存在明显的全层肌层缺损。该缺损使羊膜囊突入后穹窿。未检测到腹腔盆腔血肿。这些发现经紧急磁共振成像（MRI）证实，患者接受了剖腹手术，术中发现子宫后壁存在明显的全层缺损。由于无法继续妊娠，通过手术取出胎儿，然后进行多层处理。
我们的病例与先前报道的病例的不同之处在于症状逐渐稳定且无阴道出血。
既往宫腔镜检查会增加未来妊娠并发症的风险，如子宫破裂。
