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一例因异位妊娠导致经产妇膈肌破裂并出血性休克的罕见病例:病例报告

A Rare Case of Diaphragmatic Rupture Due to Ectopic Pregnancy Leading to Haemorrhagic Shock in a Multipara: A Case Report.

作者信息

Xiao Zelan, Long Shengfang, Yan Zhiqiang, Chen Zhen, Lin Lihui, Cao Yawen

机构信息

Department of Gynecology, Hainan Western Central Hospital, Danzhou City, Hainan Province, People's Republic of China.

Department of Obstetrics and Gynecology, Yangpu Economic Development Zone Hospital, Danzhou City, Hainan Province, People's Republic of China.

出版信息

Int J Womens Health. 2024 Oct 1;16:1653-1659. doi: 10.2147/IJWH.S478590. eCollection 2024.

Abstract

Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy. Although the underlying mechanism of this abnormal disorder is unknown, a number of risk factors have been identified, including pelvic inflammatory disease, history of pelvic surgery, intrauterine device use and previous ectopic pregnancy. Diaphragmatic rupture due to ectopic pregnancy is a rare and life-threatening condition that can lead to massive intraperitoneal haemorrhage and haemorrhagic shock. This report presents the case of a 21-year-old woman who presented with 7 weeks and 4 days of amenorrhoea and 14 hours of acute abdominal pain. On examination, she was in haemorrhagic shock with signs of acute abdomen. Emergency exploratory laparotomy revealed a haemoperitoneum of 1500 mL and active bleeding from a 3×2 cm rupture in the right hemidiaphragm. Haemostasis was achieved and the patient recovered well post-operatively. This case highlights the importance of considering diaphragmatic rupture in the differential diagnosis of acute abdomen and haemorrhagic shock, especially in patients with ectopic pregnancy.

摘要

腹腔妊娠是一种罕见且危及生命的异位妊娠形式。尽管这种异常病症的潜在机制尚不清楚,但已确定了一些风险因素,包括盆腔炎、盆腔手术史、宫内节育器使用和既往异位妊娠史。异位妊娠导致的膈肌破裂是一种罕见且危及生命的情况,可导致大量腹腔内出血和失血性休克。本报告介绍了一名21岁女性的病例,该患者停经7周4天,伴有14小时的急性腹痛。检查时,她处于失血性休克状态,伴有急腹症体征。急诊剖腹探查发现腹腔积血1500毫升,右半膈肌有一个3×2厘米的破裂口并有活动性出血。出血得到控制,患者术后恢复良好。该病例强调了在急腹症和失血性休克的鉴别诊断中考虑膈肌破裂的重要性,尤其是在异位妊娠患者中。

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本文引用的文献

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Ectopic pregnancy implanted under the diaphragm: A rare case report.膈肌下异位妊娠:一例罕见病例报告。
World J Clin Cases. 2021 Dec 26;9(36):11437-11442. doi: 10.12998/wjcc.v9.i36.11437.

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