Intraabdominalno krvarenje uzrokovano miomom u trudnoći

The prevalence of uterine myomas during pregnancy is estimated to range from 0.3% to 2.6%. Although leiomyomas usually remain asymptomatic, in one of ten cases they may be complicated. The management of uterine fibroids during pregnancy is largely conservative and surgical removal is generally delayed until post partum. A 37-year-old pregnant woman (15 weeks) with a history of gynecologic examination several hours before presented with lower abdominal pain and signs of acute abdomen. She was para-2, as she had delivered a healthy child 12 years before, and current pregnancy was uncomplicated until presentation. Intra-abdominal hemorrhage was suspected and she underwent immediate exploratory laparotomy, which revealed massive hemoperitoneum. A subserous uterine leiomyoma of 8.5x6.5 cm was found in the fundus area, with an actively bleeding ruptured vessel on its dome. Myomectomy was successfully performed and 1.5 liter of blood and blood clots were evacuated from the peritoneal cavity. The histology report showed sections of interlacing bundles of smooth muscles with areas of bleeding and necrotic degeneration. The postoperative course and subsequent antenatal period were uneventful. The woman went into spontaneous labor at 38 weeks and delivered vaginally a healthy male baby. This rare case of intra-abdominal hemorrhage due to bleeding myoma supports other recent studies, which have demonstrated that myomectomy may be successfully performed during pregnancy in selected circumstances.Pojavnost mioma maternice u trudnoći kreće se od 0,3% do 2,6%. Premda su miomi obično bez simptoma, ipak u jednom od deset slučajeva javljaju se komplikacije. Terapijski postupak kod mioma u trudnoći uglavnom je konzervativan, a općenito se njihovo kirurško uklanjanje odgađa nakon poroda. Trudnica od 37 godina u 15. tjednu trudnoće s anamnestičkim podatkom o ginekološkom pregledu nekoliko sati ranije javila se zbog bolova u donjem dijelu trbuha i sa znacima akutnog abdomena. Prije 12 godina rodila je zdravo dijete, a dosadašnji tijek trudnoće bio je uredan. Zbog sumnje na intraabdominalno krvarenje podvrgnuta je hitnoj laparotomiji, pri čem je nađeno obilno krvi u trbuhu. Nađeno je svježe krvarenje iz rupturirane krvne žile na kupoli supseroznog mioma promjera 8,5x6,5 cm smještenog na fundusu maternice. Uspješno je odstranjen miom te 1,5 litra krvi i ugrušaka iz trbušne šupljine. Patohistološki su nađena područja krvarenja i nekrotične degeneracije u snopovima glatkog mišićja. Poslijeoperacijski tijek kao i preostalo vrijeme trudnoće bili su uredni. U 38. tjednu trudnoće spontano je uslijedio vaginalni porod zdravog muškog djeteta. Ovaj rijetki slučaj intraabdominalnog krvarenja iz krvarećeg mioma u trudnoći podupire ostale novije studije koje su pokazale da se miomektomija može uspješno načiniti u posebnim okolnostima