腹腔鏡下子宮動脈卵巣動脈吻合部結紮術を施行し、子宮鏡下切除を行った胎盤ポリープの一例

抄録

Introduction: A placental polyp can cause massive bleeding at postpartum. Treatment methods for a placental polyp include uterine artery embolization and hysteroscopic resection.We report here a case in which a laparoscopic utero-ovarian anastomoses ligation was performed on a placental polyp that also supplies blood flow from the ovarian blood vessels.

Case: A 34-year-old woman, gravid 2 para 2, had a natural pregnancy with no abnormalities. She had her baby by vaginal delivery at 39 weeks of gestation. On the 16th day after she gave birth, she had sudden active genitalia bleeding. Ultrasound color Doppler and computed tomography examination revealed a tumor with abundant blood flow in the uterus, and she was diagnosed with a placental polyp. Her serum human chorionic gonadotropin (hCG) level was 3.3 mIU/mL. Uterine artery embolization was performed for hemostasis. Furthermore, there was blood flow from the ovarian artery to the mass; therefore, the ovarian artery was judged to be the blood vessel responsible for the bleed. Embolization of the ovarian artery can result in ovarian dysfunction and endometrial necrosis; therefore, ligation of the utero-ovarian anastomoses by laparoscopy was performed. After blocking the main blood flow to the placental polyp was removed by hysteroscopic resection.

Conclusion: If the ovarian artery is also the responsible blood vessel for the placental polyp, laparoscopic utero-ovarian anastomoses ligation will be also an option.