ダグラス窩に嵌頓した卵巣腫瘍合併妊娠に対して腹腔鏡下にて治療し得た1例

抄録

Background : Laparoscopic surgery for a strangulated ovarian tumor that invades the Douglas' pouch is challenging during pregnancy owing to the enlarged uterus. We report a case of total laparoscopic cystectomy using a cervical balloon for a strangulated ovarian tumor (10 cm) that invaded the Douglas' pouch in a pregnant woman.

Case : A 27-year-old gravida 0, para 0 was referred to our hospital with a left adnexal mass during the sixth week of pregnancy. Transvaginal ultrasonography and pelvic magnetic resonance imaging revealed a cystic left adnexal mass (10 cm) with septation. Laboratory investigations revealed slightly elevated serum cancer antigen 125. The patient developed abdominal pain during the 14 th week of pregnancy, and ultrasonography revealed a persistent enlarged left ovarian tumor. Therefore, we performed laparoscopic surgery at 14 weeks 1 day of the pregnancy. Intraoperatively, we detected a gravid uterus corresponding to 14 gestational weeks in size and a left ovarian tumor (10 cm) that invaded the Douglas' pouch. We could not extract the ovarian tumor from the Douglas' pouch into the pelvic cavity; therefore, a cervical balloon was inserted into Douglas' pouch followed by inflation of the balloon using 120 mL of water to lift the tumor into the pelvic cavity. The patient underwent successful cystectomy, and her postoperative course was uneventful. Histopathological evaluation confirmed the diagnosis of a "large solitary luteinized follicle cyst" , and the pregnancy continued without any issues postoperatively.

Conclusion : Our surgical technique does not require special equipment and could be useful in clinical practice.