Kime Kyungu M, Bazzett-Matabele Lisa, Nassali Mercy N, Hofmeyr G Justus
Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
Effective Care Research Unit, University of the Witwatersrand and Walter Sisulu University, East London, South Africa.
SAGE Open Med Case Rep. 2024 Oct 1;12:2050313X241284037. doi: 10.1177/2050313X241284037. eCollection 2024.
A 40-year-old patient underwent laparotomy at term gestation for a 25-cm lower abdominal mass arising from the lateral wall of the uterus, with an extensive secondary blood supply from the lower uterus and bladder, preventing access to the anterior lower uterine segment. The gravid uterus was exteriorised over the patient's thighs. A transverse posterior lower uterine segment hysterotomy was performed and a healthy 2920 g baby was delivered. A copper T 380A intrauterine device was placed at the fundus and the insertion tube passed through the cervix for retrieval after the surgery. A Foley catheter uterine tourniquet was applied to allow bloodless excision of the tumour. Histological examination confirmed a leiomyoma with extensive hyalinisation. The few prior reports of posterior lower uterine segment caesarean hysterotomy were mainly for uterine torsion or placenta accreta spectrum. It is useful to be aware of this simple though counter-intuitive approach when faced with technical difficulties.
一名40岁患者在足月妊娠时接受剖腹手术，以切除子宫侧壁上一个25厘米的下腹部肿块，该肿块有来自子宫下段和膀胱的广泛继发性血供，无法进入子宫下段前部。妊娠子宫被拖出至患者大腿上方。进行了子宫下段后壁横切口剖宫产，娩出一名健康的2920克婴儿。在子宫底部放置了一枚铜T 380A宫内节育器，插入管穿过宫颈以便术后取出。应用了福莱氏导尿管子宫止血带，以便在无血情况下切除肿瘤。组织学检查证实为伴有广泛玻璃样变的平滑肌瘤。先前关于子宫下段后壁剖宫产的报道较少，主要用于子宫扭转或胎盘植入谱系疾病。面对技术难题时，了解这种简单却与直觉相悖的方法是有用的。
