Obstetrics and Gynecology - A.M. Hromova 2000

"Acute Abdomen" in Gynecology
Impaired blood supply to internal genital tumors as a cause of "acute abdomen"
Impaired blood supply to uterine myomatous nodes

Uterine fibroids (Uterine Fibroid) represent a dyshormonal, estrogen-dependent tumor associated with disorders in the Hypothalamus-pituitary-adrenal cortex-Ovary axis, which may undergo necrosis due to poor Blood supply. Impaired Blood Circulation in myomatous nodes is most often caused by mechanical factors, such as the Torsion of the stalk of a subserous tumor, tumor compression, or compromised uterine hemodynamics (especially during Pregnancy).

Pathogenesis

Necrosis of a Fibromatous node can be either dry or wet. Dry necrosis is characterized by the gradual shrinkage of necrotic tissue areas, leading to The formation of cavernous cavities. In cases of wet necrosis, the softening of necrotic Tissues results in cyst-like cavities. During pregnancy or the postpartum period, red necrosis is more frequently observed, which is associated with pronounced venous stasis and venous thrombosis.

Aseptic necrosis may become infected via hematogenous or lymphatic routes, creating a risk of generalized Peritonitis or Sepsis.

Clinical presentation

The clinical manifestations of impaired Blood supply to a fibromatous node depend on the severity of the circulatory disturbance within the tumor.

In cases of mild node ischemia, patients complain of persistent, localized suprapubic pain without radiation or alterations in their general condition. Temperature and pulse rates remain within normal limits. The abdomen is soft, moves freely with Respiration, and shows no signs of peritoneal irritation. Blood counts are normal. Gynecological examination reveals a dense, enlarged Uterus with palpable nodes that are tender upon Palpation. Motion of the uterine cervix is painless. The vaginal fornices are deep.

Necrosis of the node manifests with acute abdominal pain. Upon palpation, the abdomen is tender and rigid, with positive symptoms of peritoneal irritation. Against the Background of elevated body temperature, a clinical blood test reveals leukocytosis and a left shift in the leukocyte differential during hourly dynamic monitoring. Bimanual examination reveals a dense, enlarged uterus containing fibromatous nodes, one of which is exquisitely tender. Ultrasound examination of the fibromatous nodes reveals areas of softening, indicating ongoing necrotic processes.

Treatment

Necrosis of a fibromatous node requires immediate surgical intervention. Supravaginal amputation or Hysterectomy is performed. It is considered appropriate to remove the uterus along with the fallopian tubes, as the latter may subsequently become a source of infection. Myomectomy is performed only when the node has a subserous Location.

Conservative myomectomy is indicated for mild node ischemia in young, nulliparous women. Spasmolytics and agents that improve blood rheology (such as rheopolyglucukin, pentoxifylline, dipyridamole) are prescribed. If conservative therapy fails and blood parameters worsen, Surgical treatment is indicated. When conservative myomectomy is performed in pregnant women, pregnancy-preserving therapy is administered postoperatively, alongside Antibiotics and detoxification infusion treatment.