Adenomyosis is a benign gynecological condition in which endometrial tissue or endometrial-like tissue develops within the uterine myometrium. Few cases of disseminated intravascular coagulation has been reported in the patients with adenomyosis. Although hysterectomy is indicated for refractory massive uterine bleeding in the patients with advanced uterine adenomyosis, conservative treatment is often desired in women in the late reproductive age. Recently such cases are increasing due to the social trend of late marriage. A 37-year-old woman with huge adenomyosis, gravida 2 para 0, was referred to our hospital to terminate her pregnancy. Acute, non-septic, disseminated intravascular coagulation (DIC) developed after early pregnancy was terminated in a woman with huge adenomyosis. Massive bleeding and DIC occurred 3 days after the dilatation and curettage. There was no evidence of infection as the cause of the DIC, because neither bacteria nor endotoxin could be detected in her blood, and antithrombin 3 (AT3), which would be expected to decrease in septic patients, was not decreased. Hemorrhage in the adenomyotic tissue after the termination presumably developed inflammation, with numerous microthrombi and necrosis in the adenomyotic tissue, which subsequently promoted coagulation and fibrinolysis, leading to the onset of massive uterine bleeding and DIC. Although severe hyperfibrinolysis is observed in peripheral blood, the fibrinolysis state in the uterine myometrium is considered to be even more severe. The newly formed clots for hemostasis under the uterine mucosa could be removed due to the excessive activation of fibrinolytic system happened in the adjacent myometrium, leading to the onset of massive uterine bleeding. Massive bleeding and DIC resolved quickly after the patient was treated with nafamostat mesilate, which is effective for both excessive coagulation and fibrinolysis. Adenomyosis could cause massive bleeding and DIC when pregnancy is terminated. Massive bleeding was considered to occur because the excessive fibrinolysis system inside adenomyosis affected the adjacent endometrium. Before considering hysterectomy to control refractory uterine bleeding, nafamostat mesilate should be considered as one option, thinking the pathophysiology of the massive bleeding due to uterine adenomyosis.

中文翻译：

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在患有严重子宫腺肌病的女性中，早期妊娠终止后，采用非无菌性弥散性血管内凝血成功地成功治疗了大面积子宫出血：病例报告。

子宫腺肌病是一种良性妇科疾病，子宫内膜在子宫内膜组织或子宫内膜样组织发育。子宫腺肌病患者很少有弥散性血管内凝血的病例报道。尽管子宫切除术适用于晚期子宫腺肌症患者难治性子宫大出血，但对于育龄晚期妇女，通常需要保守治疗。最近，由于晚婚的社会趋势，这种情况正在增加。一名37岁的巨大子宫腺肌症患者，妊娠2第0段，被转介到我们医院终止妊娠。一名早期患有巨大子宫腺肌病的妇女在怀孕初期终止了急性，非感染性弥散性血管内凝血（DIC）。扩张和刮除术后3天发生大量出血和DIC。没有证据表明感染是DIC的病因，因为她的血液中既未检测到细菌也未检测到内毒素，而脓毒症患者预期会减少的抗凝血酶3（AT3）并未减少。终止后，子宫腺肌组织中的出血可能会发炎，子宫腺肌组织中有大量微血栓和坏死，继而促进了凝血和纤维蛋白溶解，导致大量子宫出血和DIC发作。尽管在外周血中观察到严重的过度纤维蛋白溶解，但子宫肌层中的纤维蛋白溶解状态被认为更为严重。由于邻近子宫肌层发生的纤溶系统过度活化，导致子宫粘膜下止血的新形成的血块可被清除，从而导致大量子宫出血的发生。甲磺酸萘法莫他治疗后大量出血和DIC迅速消失，这对于过度凝结和纤维蛋白溶解均有效。终止妊娠时，子宫腺肌病可引起大量出血和DIC。大量出血被认为是因为子宫腺肌症内部过多的纤维蛋白溶解系统影响了邻近的子宫内膜。在考虑行子宫切除术来控制难治性子宫出血之前，应考虑甲磺酸萘法莫他作为一种选择，考虑到子宫子宫腺肌症引起的大量出血的病理生理。