阴道成形术后阴道后大面积血肿:病例报告

Kristina Sule, Francis Were
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摘要

病例介绍:一名 4+0 段产妇曾多次怀上巨大胎儿,随后四次经阴道自然分娩,均出现三度和四度会阴撕裂,导致阴道松弛,需要进行阴道成形术。术后,她出现急性尿潴留、乏力、嗜睡和面色苍白,并发现阴道后壁有大量血肿,血肿很快被排出,阴道成形术也顺利完成:讨论:尿潴留是阴道后壁血肿的独特症状,但在阴道成形术后必须考虑到这一点。在阴道成形术中,阴道后壁扩张与阴道前壁和尿道下壁相接,阻碍了膀胱的排空。阴道后壁具有弹性,能够独立容纳大量失血,且无阴道出血迹象,因此应作为阴道成形术后的检查点:结论:阴道成形术并发症的预期症状和体征是阴道出血和会阴部触痛。尿潴留、面色苍白和其他体征可能预示着阴道后血肿。妇科整形医师应考虑到阴道后壁的弹性和隐蔽性,以及其容纳巨大血肿而几乎没有征兆的能力。
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Massive postvaginoplasty retrovaginal hematoma: A case report
Case presentation: A para 4+0 with a history repeated of macrosomic fetuses and four subsequent spontaneous vaginal deliveries highlighted by third- and fourth-degree perineal tears presented with vaginal laxity requiring surgical vaginoplasty. Postoperatively, she developed acute urinary retention, weakness, lethargy, and pallor and was noted to have a massive posterior vaginal wall hematoma, which was soon evacuated, and vaginoplasty was successfully revised. Discussion: Urinary retention is a unique symptom of retrovaginal hematoma, but it must be considered following vaginoplasty. During vaginoplasty, the posterior vaginal wall expands to abut the anterior vaginal wall and inferior urethral wall, preventing evacuation of the bladder. The posterior vaginal wall is elastic and able to discretely accommodate a large amount of blood loss with no signs of vaginal bleeding and should be a point of examination following vaginoplasty. Conclusion: The expected signs and symptoms of vaginoplasty complications are vaginal bleeding and perineal tenderness. Urinary retention, pallor, and other signs can indicate a retrovaginal hematoma. Cosmetic gynecology practitioners should consider the elasticity and discreetness of the posterior vaginal wall and its ability to accommodate massive hematomas with few signs.
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