著者

水田 馨 三好 潤也 黒田 くみ子 井手上 隆史 田中 義弘 松岡 智史 吉松 かなえ 荒金 太

出版者

日本産科婦人科内視鏡学会

雑誌

日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)

巻号頁・発行日

vol.34, no.1, pp.123-127, 2018 (Released:2018-07-21)

参考文献数

19

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Ectopic pregnancy is considered as a possible diagnosis in cases in which women experience acute abdominal pain and a urinary human chorionic gonadotropin (hCG) test produces a positive result. However, we present a case of ruptured ectopic pregnancy involving a negative urinary pregnancy test result. A 34-year-old nulliparous woman was admitted to the emergency room of our hospital due to the sudden onset of lower abdominal pain. Rebound pain in the lower abdomen was detected during a physical examination. Since transabdominal ultrasonography showed massive ascites, and a urinary pregnancy test produced a negative result, we performed a contrast-enhanced computed tomography scan and found a 5-cm right-sided ovarian cyst and extravasation around the left adnexa. We diagnosed the patient with left ovarian hemorrhaging and a right ovarian hemorrhagic luteal cyst. Two hours later, hemorrhagic shock occurred, and an emergency laparoscopic operation was carried out. We detected a swollen left fallopian tube, which had ruptured and was bleeding. We performed left salpingectomy. After the operation, the patient's preoperative serum sample was re-examined to re-assess her hCG level. As a result, her serum hCG level was found to be 23.3 mIU/ml. Pathological examinations showed a very small number of chorionic villi. The final diagnosis was ectopic pregnancy. The patient's postoperative course was uneventful. This case report illustrates the difficulty of diagnosing ectopic pregnancy. Clinicians should include ectopic pregnancy in the differential diagnoses for cases of acute abdominal pain involving women of reproductive age, regardless of the results of urinary pregnancy tests.

著者

山本 勢津子 楳木 美智子 新田 愼 荒金 太

出版者

日本産科婦人科内視鏡学会

雑誌

日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)

巻号頁・発行日

vol.35, no.1, pp.199-205, 2019 (Released:2019-06-08)

参考文献数

32

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Well leg compartment syndrome (WLCS) is a rare but potentially devastating complication that is seen after gynecological, urological, and colorectal operations. We report a case of a 31-year-old woman presenting with right lower limb WLCS after laparoscopic myomectomy. The operation was performed in the lithotomy position combined with the Levitator and Trendelenburg positions and the duration of the procedure was approximately 6 hours. Both legs were attached with elastic stockings and intermittent pneumatic compression applied for prevention of deep vein thrombosis.Hemodynamic parameters of the patient were stable during the procedure. The Trendelenburg position was suspended, with the aim of preventing WLCS, for 5 minutes and 50 minutes at about 3 hours and 4 hours, respectively, from the beginning of the operation.  Immediately after the operation, the patient complained of right crural pain, yet serum creatine phosphokinase (CPK) was detected to be within the normal range (100 IU/L). The following morning, on examination, we observed foot drop, paresthesia, swelling of the right calf, and an increased CPK (5316 IU/L). Three-dimensional computed tomography (3D CT) revealed the right lower limb muscle to be swollen and edematous in the posterior compartment. Acute arterial occlusion or deep vein thrombosis was not found. Fortunately, the patient did not need to undergo fasciotomy as the foot drop recovered after 3 months.  WLCS is believed to be a life-threatening iatrogenic complication following surgery in the lithotomy position. As a result of this clinical experience, we have decided not to use elastic stockings, to mobilize the legs every 2 hours, and to take the supine position without Trendelenburg for 10 minutes at 3.5 hours from the beginning of the operation in this position. Moreover, to prevent irreversible damage, 3D CT angiography should not be delayed if WLCS is clinically suspected even in cases in which CPK is within the normal range.