Obstetrics and Gynecology, All India Institute of Medical Sciences, Muzaffarnagar, Uttar Pradesh, India.
Obstetrics and Gynecology, All India Institute of Medical Sciences, Noida, Uttar Pradesh, India
BMJ Case Rep. 2024 Sep 3;17(9):e258651. doi: 10.1136/bcr-2023-258651.
A woman in her 30s presented to emergency with complaints of acute lower abdominal pain for 3 days, not associated with any menstrual, bowel or urinary symptoms. Examination revealed an abdominopelvic mass corresponding to an 18-week gravid uterus with diffuse tenderness and guarding over her lower abdomen. The patient was a follow-up case of subserosal fibroid uterus, chronic kidney disease stage 4 and rheumatic heart disease on anticoagulants. Fibroid degeneration or torsion was suspected. Ultrasound revealed a large posterior wall subserosal fibroid with free fluid in the pelvis. As findings did not suggest degeneration or pedunculated fibroid, noncontrast CT was done, which showed a similar mass with a pedicle arising from the uterine fundus with free fluid with no other evident cause of acute abdomen. The patient was taken up for emergency laparotomy. Intraoperatively, it was found to be a case of subserosal fibroid with greater omentum adhered to it and twisted around its axis about eight times. This case is being reported to highlight a rare cause of acute abdomen.
一位 30 多岁的女性因急性下腹痛 3 天就诊，无月经、肠道或泌尿道症状。检查发现腹部和骨盆包块相当于 18 周妊娠子宫，下腹部广泛压痛和肌紧张。该患者为子宫浆膜下肌瘤、慢性肾脏病 4 期和风湿性心脏病抗凝治疗的随诊病例。怀疑肌瘤变性或扭转。超声显示子宫后壁大的浆膜下肌瘤，盆腔游离液体。由于检查结果不提示变性或带蒂肌瘤，进行了非增强 CT 检查，显示类似的肿块，有从子宫底部发出的蒂，伴有游离液体，但没有其他明显的急腹症原因。患者接受了急诊剖腹手术。术中发现为浆膜下肌瘤，大网膜与其粘连，并围绕其轴扭转约 8 圈。本病例报告旨在强调一种罕见的急腹症病因。
