閉経後女性に対し行った円錐切除術中に子宮穿孔をきたし、腹腔鏡により術中に診断、腹腔鏡下子宮全摘術によって治療し得た一例

抄録

　The squamocolumnar junction in postmenopausal women, the SCJ often regresses into the cervix; hence, conization may require deeper excision because the lesions may remain on the uterus. However, deep resection increases the risks of bleeding, infection, and cervical canal stenosis. Herein, we report the case of a postmenopausal woman who underwent laparoscopic total hysterectomy for uterine perforation during conization.

　The patient was a 57-year-old woman (G2P2) who had reached menopause at 48 years of age and had a history of depression and nervous exhaustion. She had CIN2 and tested positive for HPV16, 31, 33, and 39, prompting conization. Perioperatively, active bleeding was noted immediately after the cervical excision, which was difficult to control using sutures. Transvaginal ultrasonography revealed a hematoma in the right Douglas pauch, which raised the suspicion of uterine perforation. Emergency laparoscopy confirmed a perforation extending from the lower uterine body to the right side of the cervix with bleeding from the ascending branch of the right uterine artery. Suture repair was challenging because of the significant tissue loss; thus, TLH was performed. In this case, conization may have caused the uterine perforation. Therefore, if bleeding is difficult to stop during cervical resection or if transvaginal ultrasonography shows echogenic free space in the Douglas pauch laparoscopy should be performed to suspect intraperitoneal bleeding due to uterine perforation. Laparoscopy is useful for the reliable diagnosis of intra-abdominal bleeding due to uterine perforations.