SUCCESSFUL MYOMECTOMY DURING PREGNANCY: A CASE REPORT

Prikazan je slučaj 42-godišnje bolesnice s trudnoćom od 15 tjedana koja se javila zbog bolova u donjem dijelu trbuha, s hemodinamskom nestabilnošću, sa slikom akutnog abdomena pod sumnjom na intraabdominalno krvarenje. Nekoliko sati ranije bila je na pregledu kod ginekologa i od tada osjeća bolove u trbuhu. Ubrzo po primitku je uslijedio premještaj u operacijsku dvoranu i donja medijana laparotomija. Kod zahvata je u trbuhu nađena oko 1,5 litra krvi i ugrušaka, a na fundusu maternice supserozan miom promjera 8,5 cm. Na vrhu mioma nalazila se rupturirana krvna žila odakle je krvarila. Nakon enukleacije mioma evakuirani su krv i ugrušci. Da bi se isključila dodatna mjesta krvarenja, otvoren je i gornji dio trbuha no nalaz je bio uredan. Zahvat i postoperacijski tijek bili su uredni. Patohistološki utvrđena su manja žarišta krvarenja s hijalinom i nekrotičnom degeneracijom mioma. S 19 tjedana uslijedila je rana amniocenteza pri čemu je utvrđen uredan muški kariotip, a u 25. tjednu trudnoće cerclage zbog prohodnosti cervikalnog kanala. S navršenih 38 4 tjedana trudnoće uslijedio je vaginalni porod zdravog muškog djeteta, 3400/50, Apgara 10, 10. Prikaz bolesnice podržava stav da je miomektomija opravdana u trudnoći kod težih komplikacija, a naročito u slučajevima životne ugroženosti.A case of 42 years old woman at 15 weeks of gestation with lower abdominal pain and hemodinamical instability with signs of acute abdomen due to intraabdominal bleeding is presented. There was a history of gynaecological examination several hours earlier, and the complaints started following palpation. Soon after admission the patient underwent immediatelly to exploratory laparatomy which revealed massive hemoperitoneum. A subserosal uterine leiomyoma of 8,5 cm in size was found in the fundal 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 operation continued by dissection of the upper part of abdominal wall to explore the upper abdomen. No additional sources of bleeding were found. The histology report showed sections of interlacing bundles of smooth muscles with areas of bleeding and hyaline and necrotic degeneration. The subsequent antenatal period was uneventful. The early amniocenthesis was performed at 19 week of gestation and the finding was a normal male kariotype. At 25 weeks of gestation cervical cerclage was performed due to cervical incompetence. The woman went into spontaneous labour at 38+4 weeks of gestation and deliveried vaginally a healthy male baby weighing 3,4 kg with Apgar score 10,10. This paper supports other studies and case series that have demonstrated the safety of myomectomy during pregnancy in selected patients and especially in the situations of vital danger