Intra-abdominal hemorrhage in a pregnant woman as a manifestation of endometrioid disease
- 作者: Tezikov Y.V.1, Lipatov I.S.1, Tezikova T.A.2, Kalinkina O.B.1, Zumorina E.M.2, Amosov M.S.2, Tyutyunnik V.L.3, Kan N.E.3
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隶属关系:
- Samara State Medical University, Ministry of Health of Russia
- V.D. Seredavin Samara Regional Clinical Hospital
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
- 期: 编号 3 (2023)
- 页面: 141-148
- 栏目: Clinical Notes
- URL: https://journals.eco-vector.com/0300-9092/article/view/325838
- DOI: https://doi.org/10.18565/aig.2022.296
- ID: 325838
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Background: The effect of pregnancy on the course of endometrioid disease is ambiguous and can be implemented in both curbing the progression of the disease and activating the pathological process with the development of life-threatening conditions, particularly spontaneous intra-abdominal hemorrhage, which requires complex differential diagnosis and timely surgical tactics.
Case report: A female patient at 32 weeks of gestation was admitted to the perinatal center with complaints of lower abdomen pain. Her medical history showed that she had undergone laparoscopic enucleation of right ovarian endometrioid cyst, cauterization of single endometriotic foci, and adhesiolysis two years before this pregnancy. Threatened preterm birth was diagnosed; a thorough examination was performed. A differential diagnosis was made between acute appendicitis, pelvic vascular thrombosis, ileus, pyelonephritis, renal colic, uterine rupture, preterm placental abruption, and threatened preterm birth. Following an examination by a surgeon, a council of physicians made a decision for surgical treatment due to suspected intra-abdominal hemorrhage. Intraoperatively, there is blood in the abdominal cavity; the source of bleeding was varicose vein wall perforation in the region of the right broad ligament of the uterus; a biopsy was done. A histological examination revealed that there were foci of external genital endometriosis. A hemostatic sponge was applied to control bleeding. A caesarean section was performed. The mechanism of tissue perforation is related to rejection of highly vascularized endometrioid tissue foci with hemorrhages and necrosis in the presence of an impaired estrogen/progesterone ratio in the third trimester of pregnancy, with the development of spontaneous hemoperitoneum. To overcome diagnostic difficulties, interdisciplinary interaction was needed to achieve a favorable gestational and perinatal outcome in a pregnant woman with a life-threatening condition.
Conclusion: The accumulation of knowledge and experience in managing pregnant women with endometrioid disease will be able to optimize medical tactics and to avoid critical obstetric conditions and deaths. Each confirmed clinical observation of the course of endometrioid disease in pregnant women, which is complicated by spontaneous hemoperitoneum, is undoubtedly of scientific and practical value.
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作者简介
Yurii Tezikov
Samara State Medical University, Ministry of Health of Russia
编辑信件的主要联系方式.
Email: yra.75@inbox.ru
ORCID iD: 0000-0002-8946-501X
SPIN 代码: 2896-6986
Researcher ID: С-6187-2018
Professor, Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine
俄罗斯联邦, SamaraIgor Lipatov
Samara State Medical University, Ministry of Health of Russia
Email: i.lipatoff2012@yandex.ru
ORCID iD: 0000-0001-7277-7431
SPIN 代码: 9625-2947
Scopus 作者 ID: 6603787595
Researcher ID: С-5060-2018
Professor, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine
俄罗斯联邦, SamaraTatiana Tezikova
V.D. Seredavin Samara Regional Clinical Hospital
Email: t-tezikova@mail.ru
ORCID iD: 0000-0001-9747-9588
Deputy Chief Physician for Obstetrics and Gynecology, Perinatal Center
俄罗斯联邦, SamaraOlga Kalinkina
Samara State Medical University, Ministry of Health of Russia
Email: maiorof@mail.ru
ORCID iD: 0000-0002-1828-3008
SPIN 代码: 1260-6181
Researcher ID: I-3529-2014
Associate Professor, Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine
俄罗斯联邦, SamaraEllina Zumorina
V.D. Seredavin Samara Regional Clinical Hospital
Email: ellina.zumorina@yandex.ru
ORCID iD: 0000-0002-0140-5566
SPIN 代码: 9924-2273
Obstetrician-Gynecologist, Perinatal Center
俄罗斯联邦, SamaraMikhail Amosov
V.D. Seredavin Samara Regional Clinical Hospital
Email: jyckee@mail.ru
Obstetrician-Gynecologist, Perinatal Center
俄罗斯联邦, SamaraVictor Tyutyunnik
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: tioutiounnik@mail.ru
ORCID iD: 0000-0002-5830-5099
SPIN 代码: 1963-1359
Scopus 作者 ID: 56190621500
Researcher ID: B-2364-2015
Professor, Dr. Med. Sci., Leading Researcher at the Research and Development Service
俄罗斯联邦, MoscowNatalia Kan
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: kan-med@mail.ru
ORCID iD: 0000-0001-5087-5946
SPIN 代码: 5378-8437
Scopus 作者 ID: 57008835600
Researcher ID: B-2370-2015
Dr. Med. Sci., Deputy Director for Science
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