腹腔鏡下卵巣嚢腫摘出術後に腹腔内出血を来たし、再手術が必要であった一例

抄録

  Total laparoscopic ovarian cystectomy (TLC) is a common gynecological laparoscopic procedure and is often performed by a novice to this technique. We report a case of reoperation due to abdominal bleeding the day after TLC.

  A 26-year-old woman, gravida 2 para 2, presented with a 5 cm left ovarian cyst, presumed to be benign. TLC was performed. The next day, the patient's hemoglobin level decreased to 7.7 g/dL, and transabdominal ultrasonography revealed abdominal bleeding from the pelvic cavity to the Morrison's pouch. Laparoscopy was repeated, and suturing was performed to stop bleeding from the left ovary. Abdominal blood loss was 1300 mL. The postoperative course was uneventful, and the patient was discharged after 4 days without extra blood transfusion. Pathological diagnosis was mucinous cystadenoma.

  Excluding cases of endometrial cyst, the probability of postoperative bleeding and hematoma after TLC was reported to be 0.15% in the 2014–2015 adverse events research of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy. We considered the reason for this reoperation from two viewpoints: the technique of ovarian cystectomy and the property of laparoscopic surgery.