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Abstract: The subject of this case is a 27-year-old Miss Lin, who is usually in good health, but one day ago, after exercise, she suddenly developed pain in her abdomen and ignored it at first, but the symptoms became more and more severe, so she came to our hospital. The ultrasound examination suggested a mixed echogenic mass in the right adnexal area, and combined with the medical history, the diagnosis of “ruptured corpus luteum” was made.
Basic information】Female, 27 years old
Disease Type】Ruptured corpus luteum
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】May 2022
Treatment plan】Conservative treatment (cefuroxime sodium for injection, tranexamic acid injection, metronidazole injection) + surgical treatment (laparoscopic right ovarian repair)
Treatment period】4 days of hospitalization
Effectiveness】Surgery was successful, recovery was good, and she was discharged successfully.
I. Initial consultation
Ms. Lin described herself as unmarried and infertile with a history of sexual intercourse. After playing balloon volleyball at about 19:00 on May 22, she had lower abdominal pain, mainly in the right side of the lower abdomen, which was tolerable, with no vaginal bleeding, no fever and no anal swelling. After that, the abdominal pain gradually increased, and on May 23, she went to the outpatient clinic of the hospital. Chocolate cyst? The left adnexal area did not show any obvious abnormality, and there was no obvious fluid accumulation in the pelvis. The blood test was negative for HCG, and the diagnosis was “ruptured corpus luteum”.
(Ultrasound of uterine adnexa)
Treatment history
On admission: body temperature 36.4℃, pulse 79 times/min, respiration 20 times/min, blood pressure 123/66mmHg, clear, pressure and rebound pain in the right abdomen, abdominal muscle tension. Gynecological examination: painful cervical lifting, uterus of normal size, a fist-sized mass with indistinct borders and pressure pain could be palpated in the right adnexal area. Then Miss Lin was told: according to the medical history and examination results, the current diagnosis of right ovarian corpus luteum rupture is clear, no pelvic fluid is seen at present, indicating that the amount of bleeding is not large, you can first observe, give anti-inflammatory treatment with cefuroxime sodium for injection and tranexamic acid injection to stop bleeding, if the condition changes, then immediately give surgery.
After 1 day of observation, Ms. Lin still had obvious abdominal pain, and a repeat ultrasound indicated an enlarged mass and pelvic fluid, so she was sent to the operating room urgently for laparoscopic repair of the right ovary under general anesthesia. The rupture was sutured and the blood in the abdominal cavity was cleared. The operation was effective in stopping the hemorrhage.
III. Treatment effect
After the operation, Ms. Lin was depressed, and she was worried that it would affect her fertility. The doctor explained her condition and told her that the operation was successful and would not affect her fertility, and Ms. Lin randomly improved her mood. Ms. Lin recovered well, 4 days after the operation checkup, normal vital signs, no fever, no abdominal pain, no infection, good healing of small abdominal wounds, no redness, no hard nodules, normal blood count on recheck, given discharge. Ms. Lin expressed satisfaction with the treatment effect. In summary, through active and effective treatment, the operation was successful, with good recovery and smooth discharge.
IV. Notes
We are glad that Ms. Lin gradually recovered her health after active treatment. After discharge from the hospital, the following matters should be noted.
1.Rest: as the body becomes weak after surgery, it is recommended to take more rest and avoid strenuous exercise to help the local recovery of the wound.
2, diet: you can eat more nutritious food in appropriate amounts according to your personal preference, such as eggs, milk, beef, etc., which is beneficial to your health.
3, hygiene: after surgery, you need to pay attention to personal local hygiene, you can use warm water to wash the vulva and change underwear every morning and evening to prevent infection.
4, other: the main purpose of surgical treatment is to stop bleeding, retaining the function of the ovaries, the ovaries will still produce the corpus luteum in the future, so there is a possibility of recurrence of corpus luteum rupture, Ms. Lin again similar situation, to seek early medical attention.
V. Personal insight
Luteal rupture occurs in young women with strong ovarian function, the corpus luteum is formed after ovulation, so luteal rupture occurs in the second half of the menstrual cycle, when women exercise vigorously, sexual intercourse, forceful defecation and other squeezing and impact on the abdomen, it is easy to induce luteal rupture. If the rupture of the corpus luteum bleeds little, often can stop bleeding on its own, Ms. Lin’s symptoms are not obvious, but once it causes a lot of bleeding, it will cause significant abdominal pain, and even cause symptoms of hemorrhagic shock, need to be operated as soon as possible to stop bleeding to be effective.