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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Número 01

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Ginecol Obstet Mex 2021; 89 (01)


Inversión uterina total, secundaria a leiomioma submucoso

Martínez-Rodríguez JJ, Velázquez-Castellanos PI, Macías-Vera NN, Antonio-Matías LJ

Idioma: Español
Referencias bibliográficas: 42
Paginas: 58-70
Archivo PDF: 229.34 Kb.


RESUMEN

Antecedentes: La inversión uterina es una complicación del parto poco frecuente que se produce inmediatamente después de expulsar la placenta; consiste en la inversión del útero dentro de su propia cavidad.
Caso clínico: Paciente de 49 años, originaria y residente del Estado de México, con índice de masa corporal de 21.4 kg/m2, negó antecedentes crónico-degenerativos y toxicológicos. Antecedentes de interés: 3 embarazos, 3 partos, en etapa de transición a la menopausia. El padecimiento actual se había iniciado 6 meses antes, con sangrado uterino anormal, caracterizado por hiperpolimenorrea. En la exploración física dirigida se observó el prolapso de órganos pélvicos, con inversión de las estructuras uterinas, asociado con un proceso infeccioso severo, con datos clínicos de choque hipovolémico y riesgo de disfunción orgánica debido a la sepsis. Se sospechó inversión uterina que se trató con transfusión de hemoderivados y antibióticos. La histerectomía abdominal evidenció la inversión uterina secundaria al mioma submucoso. El estudio histopatológico confirmó el diagnóstico y descartó la malignidad. Su evolución fue adecuada y se dio de alta del hospital a los 8 días posteriores a la intervención quirúrgica.
Conclusiones: El diagnóstico es difícil; sin embargo, el antecedente de tumor en el útero asociado con el cuadro clínico descrito hizo sospechar el problema. En pacientes muy jóvenes o en etapa posmenopáusica es importante descartar un tumor maligno. El acceso quirúrgico dependerá de las habilidades del cirujano.


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