Rupture spontanee de varice uterine au cours du deuxieme trimestre de grossesse : a propos de un (01) cas au CHU SO.:

Introduction: La rupture de varice uterine pendant la grossesse est rare. Ses manifestations font penser a d’autres affections plus frequentes neanmoins, le praticien doit toujours l’avoir a l’idee.Objectif: Nous rapportons un cas survenu a 23 semaines d’amenorrhee+3jours et faire une revue de la litterature.Observation: Gestante de 32 ans, 3eme geste 2eme pare, sans antecedent particulier, consulte au CHU Sylvanus Olympio a 23SA+2jours pour douleur abdomino-pelvienne de survenue brutale avec vomissements. L’examen a permis de noter, un febricule, des conjonctives moyennement colorees, une tension arterielle(TA) a 110/70mmHg, un pouls a 102ppm, un syndrome d’irritation peritoneale. Au toucher vaginal: col posterieur long, ramolli, ferme, gant ramenant de leucorrhee physiologique. L’hemogramme montrait une hyperleucocytose et un TH a 10,5gdl-1. L’echographie abdominopelvienne a mis en evidence un epanchement liquidien intra-peritoneal abondant et une grossesse intra-uterine evolutive correspondant a l’âge gestationnel. L’hypothese de peritonite appendiculaire ou rupture hemorragique d’un kyste del’ovaire a ete posee, une laparotomie exploratrice indiquee. A l’ouverture, decouverte d’hemoperitoine abondant dont l’aspiration a ramene1,5L. Nous avons visualise un saignement en jet d’un point a la face posterieure de l’uterus, a environ 1cm d’insertion d’utero-sacre droit. Nous avons effectue l’homostase par un point en ‶X″. Les suites operatoires immediates etaient simples; cependant, nous avons note un deces foetal a J6 postoperatoire suivi d’une expulsion.Conclusion: Malgre sa rarete, le diagnostic de rupture de varice uterine doit toujours rester a l’esprit du clinicien face a une gestante presentant une douleur abdominale d’apparition brutale, ne cedant pas aux antalgiques classiques.ABSTRACT:Introduction: Rupture of Uterine varicose veins during pregnancy is rare. Its manifestations are reminiscent of other more frequent ailments however, the practitioner should always keep it in mind.Objective: We report a case occurring at 23weeks of amenorrhoea+3days and conduct a literature review.Observation: A 32 years old pregnant woman, 3rd gesture and 2nd parity, with no particular disease history, consulted at the Sylvanus Olympio CHU maternity hall at 23rd weeks of pregnancy+2days for a sudden onset of abdomino-pelvic pain associated of vomitings. The physical examination noted a fever, moderately colored conjunctiva, a blood pressure of 110/70mmHg, a pulse of 102ppm, and peritoneal irritation syndrome. On vaginal exam: the cervix is long, posterior, soft, closed with gloves bringing back physiological leucorrhoea. The Cells blood counts showed hyperleukocytosis and Haemoglobin level at 10.5gdl1-1. An Abdomino-pelvic ultrasound performed showed an abundant intraperitoneal fluid effusion and an evolutive intrauterine pregnancy consistent with gestational age. The hypothesis of appendicular peritonitis or hemorrhagic rupture of an ovarian cyst was made, an exploratory laparotomy indicated. Upon opening, we discovered an abundant hemoperitoneum Whose aspiration brought back 1.5L. We visualized a jet bleeding from a point on the posterior surface of the uterus, approximately 1cm from the right uterosacral insertion. We performed the hemostasis at an ‶X″ point. The immediate post-surgery consequences were simple; however, we noted a fetal death on day six postsurgery followed by expulsion.Conclusion: Despite its rarity, the diagnosis of a ruptured uterine varicose vein should always be kept in mind by the clinician when dealing with a pregnant woman presenting a sudden onset of abdominal pain, which does not give way to conventional analgesics.