绝经后女性宫内节育器相关卵巢脓肿术后继发脑脓肿一例

doi:10.12280/gjszjk.20240271

摘要/Abstract

摘要：

脑脓肿是卵巢脓肿的罕见并发症，在卵巢脓肿术后，即使经过抗感染治疗，仍可发生。报告1例57岁女性，在当地基层医院行宫内节育器取出术后出现排尿障碍伴下腹痛，考虑卵巢脓肿，行卵巢脓肿切除术。术后1个月患者出现持续性高热、头痛，磁共振成像提示为脑脓肿，给予抗感染、降低颅内压、纠正低白蛋白血症等治疗，病情稳定后出院。患者定期门诊复查，出院8个月后影像结果提示痊愈。结合该病例，总结卵巢脓肿术后继发脑脓肿的发病机制、临床表现、诊疗方法及预防。

关键词: 卵巢, 脓肿, 脑脓肿, 人葡萄球菌, 宫内节育器, 宏基因组, 高通量核苷酸序列分析

Abstract:

Brain abscess as a rare complication of ovarian abscess can occur even after anti-infective treatment following ovarian abscess surgery. We report a case of a 57-year-old postmenopausal woman who developed urinary difficulty and lower abdominal pain after intrauterine device removal in a local hospital. She was diagnosed with ovarian abscess and underwent ovarian abscess resection. One month post-surgery, the patient presented with persistent high fever and headache. She was diagnosed as a brain abscess by magnetic resonance imaging, and treated by anti-infection, intracranial pressure reduction, and correction of hypoalbuminemia. The patient was discharged after her condition stabilized. Regular outpatient follow-ups were conducted, and imaging results indicated the complete recovery after eight months of discharge. We summarize the pathogenesis, clinical manifestations, diagnosis, treatment and prevention of secondary brain abscess following ovarian abscess surgery.

Key words: Ovary, Abscess, Brain abscess, Staphylococcus hominis, Intrauterine devices, Metagenome, High-throughput nucleotide sequencing

白若妍, 王炎强, 陈京霞. 绝经后女性宫内节育器相关卵巢脓肿术后继发脑脓肿一例[J]. 国际生殖健康/计划生育杂志, 2024, 43(6): 485-489.

BAI Ruo-yan, WANG Yan-qiang, CHEN Jing-xia. A Case of Brain Abscess Secondary to Intrauterine Device-Related Ovarian Abscess in A Postmenopausal Woman[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(6): 485-489.

图/表 3

图1 2022年5月10日患者颅脑MRI图注：A 轴位弥散加权成像（diffusion weighted imaging，DWI），B 冠状位T1增强，C 矢状位T1增强，D 轴位T1增强。轴位DWI示左侧小脑半球明显高信号，边缘见环形低信号影，大小约9~14 mm；冠状位、矢状位、轴位T1增强示左侧小脑半球及小脑幕下病变，环形强化，考虑为脑脓肿，并累及临近脑膜，均如箭头所示。

图2 2022年5月27日患者颅脑MRI图注：A 轴位DWI，B 冠状位T1增强，C 矢状位T1增强，D 轴位T1增强。轴位DWI示左侧小脑半球明显高信号，边缘见环形低信号影，大小约8 mm；冠状位、矢状位、轴位T1增强示左侧小脑半球环形明显强化，内壁光整，周围水肿区无明显强化；左侧小脑慕下脓肿明显缩小，局部脑膜增厚，均如箭头所示。

图3 2023年2月26日患者颅脑MRI图注：A 轴位DWI，B 冠状位T1增强，C 矢状位T1增强，D 轴位T1增强。轴位DWI示左侧小脑半球软化灶形成，大小约4 mm，如箭头所示；冠状位、矢状位、轴位T1增强示脑实质内未见明显异常强化，脑膜均匀未见明显异常强化。

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