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Abstract
Background
Spontaneous hemoperitoneum in pregnancy or the postpartum period is an uncommon but potentially life-threatening complication.
Case
A 29-year-old woman presented with severe abdominal pain, decreased consciousness, and a reduced hemoglobin level three days after an uneventful spontaneous vaginal delivery. Initial ultrasound and CT imaging showed significant hemoperitoneum with no identifiable cause. Laparoscopic surgery was performed, during which bleeding from the left uterine artery was identified and resolved with laparoscopic internal iliac artery ligation. Concomitant cul-de-sac obliteration and adhesions secondary to decidualized endometriosis were found.
Conclusion
Decidualized endometriosis is a possible etiologic factor in spontaneous hemoperitoneum. Prompt diagnosis and treatment are critical for improving outcomes. When surgical intervention is indicated, a laparoscopic approach should be considered because of its minimally invasive nature and shorter recovery time.
Résumé
Contexte
L’hémopéritoine spontané pendant la grossesse ou la période postpartum constitue une complication peu courante, mais potentiellement mortelle.
Case
Une femme de 29 ans présentait de graves douleurs abdominales, une conscience amoindrie et un taux d’hémoglobine réduit, trois jours à la suite d’un accouchement vaginal spontané sans incident. L’échographie et le tomodensitogramme initiaux révélaient un hémopéritoine considérable sans cause identifiable. Une chirurgie laparoscopique a été menée; au cours de celle-ci, des saignements issus de l’artère utérine gauche ont été identifiés et rectifiés au moyen de la ligature laparoscopique de l’artère iliaque interne. Une oblitération concomitante du cul-de-sac et des adhérences attribuables à une endométriose décidualisée ont été constatées.
Conclusion
L’endométriose décidualisée constitue un possible facteur étiologique de l’hémopéritoine spontané. Le diagnostic et la prise en charge rapides s’avèrent cruciaux pour l’amélioration des issues. Lorsqu’une intervention chirurgicale s’avère indiquée, le recours à une approche laparoscopique devrait être envisagé en raison de sa nature minimalement effractive et du court temps de récupération qu’elle nécessite.
Key Words
REFERENCES
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Article info
Publication history
Accepted:
August 19,
2010
Received:
August 15,
2010
Footnotes
Competing Interests: None declared.
Identification
Copyright
© 2010 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.
