婦人科医が遭遇した特発性大網出血症例に対する検討―卵巣出血との鑑別―

抄録

  The case was a 34-year-old female. Upon consultation at an ER with pain in the right abdomen, abdominal computed tomography (CT) revealed fluid in the abdominal cavity, leading to consultation at the department of gynecology in view of ovarian hemorrhage. Leakage of the contrast agent was suspected near the left ovary as a result of contrast enhanced CT; however other reasons of intra-abdominal hemorrhage were suspected since she was not in the ovulatory phase and there was no sexual intercourse leading to surgical consultation. Although her vital signs were stable, decrease in hemoglobin was recognized and laparoscopic operation was performed to identify the source of intra-abdominal hemorrhage and to stop bleeding. As a result, ovarian hemorrhage was not recognized and the bleeding site was confirmed in the greater omentum; leading to diagnosis of idiopathic omental hemorrhage. Furthermore, extensive omental adhesion was confirmed due to previous operation of appendicitis accompanying peritonitis. This report suggests the possibility to detect leakage of the contract agent at an unexpected location in the case of intra-abdominal adhesion in consideration of the rare female case with idiopathic omental hemorrhage by adding some bibliographic consideration.