Hsieh Wan-Ling, Hsiao Tsun-Wen, Chu Chang-Yao, Tsai Yung-Chieh
Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.
Int J Gynaecol Obstet. 2025 Jun 19. doi: 10.1002/ijgo.70300.
Spontaneous uterine rupture is a rare, life-threatening condition typically seen in gravid women with a history of uterine surgery or trauma. This report presents an unusual case of spontaneous uterine rupture in a 29-year-old virgin, highlighting the critical importance of early diagnosis and intervention, even in the absence of typical risk factors. A 29-year-old nulliparous woman presented with acute onset of severe lower abdominal pain during menstruation. She had no history of sexual activity, uterine surgery, or trauma. A high index of suspicion for spontaneous uterine rupture was raised following a computed tomography (CT) scan. An emergent exploratory laparotomy revealed a rupture at the uterine fundus with extensive necrosis, necessitating a total hysterectomy. Histopathological examination confirmed adenomyosis with significant hemorrhage and vascular thrombosis, without evidence of infection or malignancy. Subsequent investigations identified protein-S deficiency, which may have contributed to a hypercoagulable state. This combination of factors led to localized ischemia and structural compromise of the uterine wall, ultimately leading to spontaneous rupture. This case underscores the importance of considering spontaneous uterine rupture in the differential diagnosis of acute abdominal pain in women, regardless of conventional risk factors. The coexistence of adenomyosis and protein-S deficiency might have synergistically contributed to uterine wall compromise and rupture. Early recognition and prompt intervention are essential to prevent severe complications, and evaluation for underlying coagulopathies should be considered to guide management and reduce the risk of adverse outcomes.
自发性子宫破裂是一种罕见的、危及生命的疾病，通常见于有子宫手术或创伤史的孕妇。本报告介绍了一例29岁处女发生自发性子宫破裂的不寻常病例，强调了早期诊断和干预的至关重要性，即使在没有典型危险因素的情况下也是如此。一名29岁未育女性在月经期间出现急性严重下腹痛。她没有性活动、子宫手术或创伤史。计算机断层扫描（CT）后，对自发性子宫破裂的高度怀疑被提出。急诊剖腹探查显示子宫底部破裂并伴有广泛坏死，需要进行全子宫切除术。组织病理学检查证实为子宫腺肌病伴大量出血和血管血栓形成，无感染或恶性肿瘤证据。随后的检查发现蛋白S缺乏，这可能导致了高凝状态。这些因素共同导致子宫壁局部缺血和结构受损，最终导致自发性破裂。该病例强调了在女性急性腹痛的鉴别诊断中考虑自发性子宫破裂的重要性，无论是否存在传统危险因素。子宫腺肌病和蛋白S缺乏的共存可能协同导致子宫壁受损和破裂。早期识别和及时干预对于预防严重并发症至关重要，应考虑评估潜在的凝血障碍以指导治疗并降低不良结局的风险。
