子宮鏡下筋腫核出術で子宮穿孔を起こし後腹膜血腫が生じた一例

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Introduction: Few reports have described retroperitoneal hematoma around the infundibulopelvic ligament originating as a complication of hysteroscopic surgery. We report a case of retroperitoneal hematoma around the infundibulopelvic ligament secondary to uterine perforation during hysteroscopic myomectomy.

Case presentation: A 43-year-old woman presented with menorrhagia and a submucosal fibroid. Magnetic resonance imaging revealed a submucosal fibroid (basal diameter 20 mm). Hysteroscopic myomectomy was performed and using a loop monopolar electrode, we excised a submucosal fibroid (20 cm) that originated from the bottom of the uterus.

  The peritoneal cavity could be visualized from within the uterus, and we diagnosed the patient with a uterine perforation for which we performed immediate laparoscopic repair under general anesthesia. Intraoperatively, we detected a perforation (5 mm in size) at the bottom of the uterus. We also identified a hematoma (3 cm) on the dorsal aspect of the broad ligament at the site of physiological adhesions with the sigmoid colon. We repaired the uterine perforation; however, the hematoma ruptured during intraoperative exploration. Bleeding was successfully controlled with compression. The retroperitoneal hematoma detected around the infundibulopelvic ligament could be attributed to compression injury caused by a Hegar dilator, head of hysteroscope, the laparoscopic port, or indirect injury from energy devices.

Conclusion: Laparoscopy or laparotomy is necessary for meticulous visualization of the abdominal cavity in cases of uterine perforation during hysteroscopic surgery.