PDF(Pubmed)
Abstract：
A perimenopausal woman with a known history of fibroid uterus presented to the emergency department with the chief complaint of three weeks of intermittent abdominal pain with acute worsening for two days. The pain was described as 10/10 \"tearing\" peri-umbilical pain with radiation to the rectum associated with nausea. Vital signs, laboratory results, and physical examination were largely unremarkable at presentation, aside from diffuse tenderness with rebound. Computed tomography revealed a markedly enlarged uterus and large-volume hemoperitoneum and sentinel clot sign, suggesting fibroid as the source of bleeding. Upon re-examination, the patient was found to be hypotensive and tachycardic with worsening hemoglobin, worsening abdominal distension, and a positive focused assessment with sonography in trauma (FAST) exam. Although the source of bleeding was non-specific, a decision was made by the gynecology and general surgery teams to perform an emergency exploratory laparotomy. A midline vertical incision was made and four liters of blood were evacuated from the peritoneal cavity. The gynecology and general surgery teams thoroughly inspected the abdomen. A myomectomy was performed and good hemostasis was confirmed. The patient was transferred to the surgical intensive care unit, where she had an uncomplicated post-operative course. She was discharged home on postoperative day 4. Uterine fibroid rupture should be on the differential for hemoperitoneum in a patient with known fibroids and should be addressed with a timely multi-specialty approach.
摘要：
一名已知子宫肌瘤病史的围绝经期妇女就诊于急诊科，主诉为间歇性腹痛三周，并急性恶化两天。疼痛被描述为10/10“撕裂”脐周疼痛，并与恶心相关的直肠放射。生命体征,实验室结果,体检在介绍时基本上没有什么显著的，除了有反弹的弥漫性压痛。计算机断层扫描显示子宫明显增大，大体积腹膜和前哨血块征，提示纤维瘤是出血的来源.重新检查后，患者被发现低血压和心动过速，血红蛋白恶化，腹胀加重,以及创伤超声检查（FAST）检查的积极聚焦评估。虽然出血来源是非特异性的，妇科和普外科团队决定进行紧急剖腹探查术.进行中线垂直切口，并从腹膜腔抽出4升血液。妇科和普外科小组彻底检查了腹部。进行了子宫肌瘤切除术，并确认了良好的止血效果。病人被转移到外科重症监护室,在那里她有一个简单的术后课程。她在术后第4天出院回家。对于已知肌瘤的患者，子宫肌瘤破裂应与腹膜积血有关，并应及时采用多专业方法解决。
