Pitfall in the treatment of endometriosis: A case of hemoperitoneum during pregnancy after laparoscopic surgery

概要

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Objective: To discuss the risk of hemoperitoneum during pregnancy after laparoscopic surgery for the treatment of endometriosis Case: A 32-year-old primigravida underwent Cesarean section at 36 weeks and 1 day gestation due to hemoperitoneum and non-reassuring fetal status. Four months before her pregnancy, she had undergone laparoscopic surgery for the treatment of endometriosis and infertility. At laparotomy, bleeding was noted from a left ovarian endometrioma and at the right sacro-uterine ligament, points which were exactly coincident with those identified during the laparoscopic procedure. Total blood loss approached 5,000 mL, but the patient was resuscitated after appropriate hemostasis and transfusion. Conclusion: Ectopic endometriotic tissue is known to be decidualized during pregnancy, becoming very fragile and prone to bleeding. Therefore, endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. In addition, surgical intervention for peritoneal endometriotic lesions makes surrounding vessels and tissues more friable and exacerbates the fragility. Therefore, careful attention must be paid during pregnancy in women who have a history of surgical intervention for deep infiltrating endometriosis.