Kuzma Alexandra, Shah Khooshali, Kallen Caleb, Jun Erin
Obstetrics and Gynecology, Crozer-Chester Medical Center, Upland, USA.
Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Willoughby, USA.
Cureus. 2024 Oct 4;16(10):e70825. doi: 10.7759/cureus.70825. eCollection 2024 Oct.
Trichloroacetic acid (TCAA) solution is used to treat vulvar condyloma and cervical intraepithelial neoplasia. Saline infusion sonohysterography (SIS) detects intrauterine pathology and fallopian tube patency in infertile patients. A 33-year-old Caucasian nulliparous fertility patient presented to the emergency department with extensive burns following accidental intrauterine instillation of TCAA during SIS with tubal perfusion. On presentation, the patient was hemodynamically stable. There was extensive erythema and tenderness in a spill/burn pattern on both thighs as well as the groin, perineum, and labia. Speculum exam revealed white, leathery mucosa with the absence of normal vaginal rugae. The abdominal exam was notable for generalized tenderness without guarding or rebound. Complete blood count (CBC), serum electrolytes, and CT scan were unremarkable. The patient was admitted for observation and pain management. She received serial abdominal exams, topical aquaphor, vaginal estrogen, and serial labs and pelvic imaging. The patient remained stable and was discharged on hospital day two. At three months, the patient reported improvement in pain and gradual skin healing. She resumed fertility treatment at a different fertility center, and a frozen embryo transfer resulted in a live birth. This case demonstrates severe vaginal and perineal injury after intrauterine instillation of TCAA. At three months, vaginal and external genitalia required ongoing burn care. Notably, endometrial recovery is evidenced by the delivery of a live birth after embryo transfer. The case underscores a preventable medical accident and highlights the regenerative ability of endometrial stem cells to respond to hormonal cues and restore endometrial receptivity after chemical trauma.
三氯乙酸（TCAA）溶液用于治疗外阴尖锐湿疣和宫颈上皮内瘤变。盐水灌注子宫输卵管声学造影（SIS）用于检测不孕患者的子宫内病变和输卵管通畅情况。一名33岁的白种人未生育的不孕患者在进行输卵管灌注的SIS检查时意外子宫内注入TCAA后，因大面积烧伤被送往急诊科。就诊时，患者血流动力学稳定。双大腿以及腹股沟、会阴和阴唇出现大面积红斑和压痛，呈溢出/烧伤样。窥器检查发现白色、似皮革样的黏膜，无正常阴道皱襞。腹部检查可见广泛性压痛，但无肌紧张或反跳痛。血常规（CBC）、血清电解质和CT扫描均无异常。患者入院观察并进行疼痛管理。她接受了系列腹部检查、外用凡士林、阴道雌激素治疗以及系列实验室检查和盆腔影像学检查。患者病情保持稳定，于住院第二天出院。三个月时，患者报告疼痛有所改善，皮肤逐渐愈合。她在另一家生殖中心恢复了生育治疗，冻融胚胎移植后成功分娩。该病例表明子宫内注入TCAA后会导致严重的阴道和会阴损伤。三个月时，阴道和外生殖器仍需持续的烧伤护理。值得注意的是，胚胎移植后成功分娩证明了子宫内膜的恢复。该病例强调了一起可预防的医疗事故，并突出了子宫内膜干细胞在化学创伤后对激素信号作出反应并恢复子宫内膜容受性的再生能力。
