سوراخ شدن رحم خانم باردار حين كوله‌سيستكتومي لاپاروسكوپيك: گزارش موردي

A uterine perforation during laparoscopic cholecystectomy: case report

زمينه و هدف: لاپاروسكوپي در دوران باردراي براي درمان كوله‌سيستيت جايگاه ويژه و قابل قبولي دارد. عوارض لاپاروسكوپي دوران بارداري مي‌تواند منحصر به‌فرد باشد كه يكي از آن‌ها سوراخ شدن رحم است. آشنايي با عوارض لاپاروسكوپي در دوران بارداري به مديريت اين بيماران كمك مي‌كند. معرفي‌بيمار: بيمار ما زن 24 ساله با سن بارداري 28 هفته بود كه در دي‌ماه 1395 با تشخيص كوله‌سيستيت در بيمارستان آموزشي وابسته به دانشگاه علوم پزشكي مشهد تحت لاپاروسكوپي قرار گرفت. هنگام ورود تروكار به داخل شكم سوراخ شدن رحم به همراه نشت مايع آمنيوتيك به داخل شكم رخ داد كه بلافاصله توسط جراح ترميم انجام شد. كنترل قلب جنين در اتاق عمل صورت گرفت. پس از اطمينان از وضعيت مناسب جنين و مادر، مادر به مدت يك هفته در بخش زنان تحت مراقبت قرار گرفت. در سونو سريال حجم مايع آمنيوتيك نرمال بود. بيمار پس از مراقبت‌هاي كامل دوارن بارداري در سن حاملگي 38 هفته سزارين شد و نوزاد سالم با آپگار مناسب متولد شد. نتيجه‌گيري: سوراخ شدن رحم حين لاپاروسكوپي در صورتي‌كه به درستي تشخيص داده شده و اداره شود معمولا با خطر چشمگيري براي مادر و جنين همراه نمي‌باشد.

Background: Laparoscopy is an acceptable procedure for cholecystitis in pregnancy. Laparoscopic complications during pregnancy can be unique. Uterine perforation is a rare complication during laparoscopy of pregnant women. Acquaintance with this complication can help surgeons and gynecologist to manage these patients properly. We will report a case of uterine perforation during laparoscopy. Case presentation: Our patient was a 24-year pregnant woman with gestational age of 28 weeks. She had nausea and vomiting and right upper quadrant tenderness, she was admitted in surgery ward on January 2017 in an academic hospital in Mashhad and candidate for laparoscopic cholecystectomy with diagnosis of cholecystitis. Her fundal height was 28 centimeters. Laparoscopy was done with Hasson technique and three punctures. During abdominal trocar insertion uterine perforation occurred. Amniotic fluid leaked in the abdomen. Perforation repaired immediately and then cholecystectomy was done. Fetal heart rate was normal. After surgery according to stable vital signs and absence of bleeding and contraction, the patient was transferred to the midwifery department. The patient received one course of betamethasone for fetal lung maturation. Antibiotic therapy initiated. During the hospitalization, the patient was monitored daily for vital signs (fever and tachycardia), uterine contraction, vaginal bleeding and vaginal bleeding. Daily fetal heart monitoring was performed. After close prenatal care cesarean section was done in 38 weeks of pregnancy and a healthy baby was born with appropriate Apgar score. Conclusion: Laparoscopy in pregnant women is usually safe.Pregnancy-specific complications such as uterine injury are not common, but with a series of precautions before and during surgery. These complications can be reduced. Uterine perforation during laparoscopy if properly managed is usually not associated with significant risk