慢性骨髄性白血病を背景に発症した大量卵巣出血を腹腔鏡下に止血した一例

抄録

　Ovarian hemorrhage occurs in women across a broad age range; however, conservative therapy effectively controls bleeding in most cases. Notably, in some patients, it can lead to massive life-threatening bleeding, which necessitates surgical intervention and exploration of the underlying contributors. We report a case of ovarian bleeding associated with intra-abdominal hemorrhage (2,900 ml) in a patient with chronic myeloid leukemia. A 32-year-old nulligravida was urgently referred to our facility in a state of shock secondary to significant intra-abdominal bleeding. Initial evaluation revealed a serum hemoglobin level of 4.7 g/dl, white blood cell count of 217,000/μl, and platelet count of 53.5 × 10⁴/μl, with abnormal blood cell parameters. Exploratory laparoscopy led to diagnosis of left ovarian bleeding. Subsequent postoperative investigations confirmed concomitant chronic myeloid leukemia. Myeloproliferative disorders, including chronic myeloid leukemia, can lead to the development of acquired von Willebrand syndrome (aVWS). An increase in the platelet count in myeloproliferative disorders is associated with aVWS, which paradoxically causes a bleeding tendency. In addition to significant ovarian bleeding, aVWS may cause postoperative port-site bleeding. Although aVWS is considered rare, evidence suggests that it occurs at a high frequency in patients with specific underlying conditions.