子宮鏡下子宮筋腫摘出術中に子宮内膜症病変から腹腔内出血を生じた1例

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CASE: A 41-year-old gravida 1, para 1 presented with dysmenorrhea and anemia. Magnetic resonance imaging revealed a left-sided endometriotic cyst (45 mm) and a submucosal uterine fibroid (48 mm). She underwent hysteroscopic myomectomy and laparoscopic adnexal resection, following 3-month pseudomenopausal therapy.

  Hysteroscopic surgery involved fragmentation and removal of the myoma, which weighed 67 g. Subsequently, we performed laparoscopic surgery, and intraoperatively we observed intra-abdominal bleeding that extended to the liver surface. The source of bleeding was identified as the ruptured broad ligament. We performed left adnexal resection after satisfactory hemostasis was achieved. The estimated intraperitoneal hemorrhage was 900 mL. Transabdominal ultrasonography performed upon completion of hysteroscopic surgery could not identify the source of intra-abdominal bleeding. However, subsequent immediate laparoscopic surgery successfully detected the bleeding source. Hysteroscopic myomectomy should be performed cautiously in patients with endometriosis.