妊娠初期の卵巣出血に対し、自己血回収装置を用いて腹腔鏡下止血術をしえた1症例

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We report a case of ovarian hemorrhage at 4 weeks of pregnancy that was managed with laparoscopic surgery with intraoperative autologous blood transfusion (IABT) and not homologous blood transfusion. We suspected ectopic pregnancy in a 37-year-old woman (para 2; postmenstrual day 32) because ultrasonography revealed massive hemoperitoneum and no gestational sac in the uterus, in spite of increased serum human chorionic gonadotropin (HCG) (4084 mIU/ml), and an emergency laparoscopic surgery was performed. Continuous bleeding from the surface of the left ovary was apparent. Corpus luteum and not chorion was detected; partial resection and coagulated hemostasis of the left ovary was performed. We aspirated 1350 ml of blood and reinfused 650 ml with IABT. Homologous blood transfusion was not required. Four days post-surgery (5 weeks of pregnancy), the gestational sac was detected in the uterus. Pathological examination revealed normal ovarian tissue with hemorrhage. The course of pregnancy was uneventful, and she delivered at 38 weeks of pregnancy. Although corpus luteum hemorrhage is commonly observed and safely followed without treatment, surgery is required for life-threatening hemorrhage. It is difficult to distinguish the findings of a ruptured corpus luteum without a detectable gestational sac at early pregnancy from ectopic pregnancy, and surgery is required for accurate diagnosis and hemostasis. Laparoscopic surgery with IABT avoids or reduces the need for homologous blood transfusion and is a safe and minimally invasive treatment for massive hemoperitoneum.
日本産科婦人科内視鏡学会の論文
2009-09-01

妊娠初期の卵巣出血に対し、自己血回収装置を用いて腹腔鏡下止血術をしえた1症例

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