Tags

Type your tag names separated by a space and hit enter

Laparoscopic Removal of an Abdominal Pregnancy in the Pelvic Sidewall.
J Minim Invasive Gynecol 2019 Sep - Oct; 26(6):1007-1008JM

Abstract

STUDY OBJECTIVE

To describe the presentation, diagnosis, and management of a patient with abdominal pregnancy and to illustrate the laparoscopic technique used to manage this patient.

DESIGN

A descriptive study approved by our local Institutional Review Board. Consent was given from the patient.

SETTING

A university hospital in Ashdod, Israel.

PATIENT

On May 15th 2018, a gravida 3, para 2, 37-year-old asymptomatic patient was referred to our hospital's gynecologic emergency department due to a suspected ectopic pregnancy. The patient had no relevant medical or surgical history. Her obstetric history consisted of 2 spontaneous vaginal deliveries with no other significant gynecologic history. Her menses were regular every month. Her last menstrual period was 6 weeks before presentation. Her β-human chorionic gonadotropin (hCG) level measured on the day before presentation was 24,856 IU/L. Physical examination was unremarkable except for a small amount of brownish vaginal discharge. A transvaginal ultrasound (TVUS) exam on presentation did not demonstrate an intrauterine gestational sac, but revealed a gestational sac and a fetus next to the right adnexa, with a crown-rump length of 1.3 cm, consistent with 7+3 gestational weeks. There was a minimal amount of fluid in the pouch of Douglas.

INTERVENTION

Owing to an extrauterine pregnancy with high β-hCG value, laparoscopic operative management was chosen. On entrance to the abdominal cavity, a normal uterus and 2 ovaries and fallopian tubes were observed. A small to moderate amount of blood was present in the pouch of Douglas. a 3- to 4-cm distension was noted over the right uterosacral ligament. Following delicate probing of the area, moderate to severe bleeding commenced, which was initially controlled with local pressure and oxidized regenerated cellulose. An intraoperative TVUS identified an abdominal pregnancy in the right pelvic sidewall. The gestational sac was completely dissected and removed following ureterolysis and separation of the right ureter from the specimen. Local injection of vasopressin was also used. The β-hCG level before surgery of 19,008 IU/L decreased to 6339 IU/L on postoperative day 1. The patient was discharged in good condition on postoperative day 2. A final histopathological report confirmed a gestational sac.

MEASUREMENT AND MAIN RESULTS

This patient referred for a tubal ectopic pregnancy was eventually diagnosed with an abdominal pregnancy and was treated operatively with complete excision of the abdominal pregnancy, which was located at the right pelvic sidewall.

CONCLUSION

Abdominal pregnancy is a rare type of ectopic pregnancy with a reported incidence of 1:10,000 to 1:30,000 pregnancies, and accounts for approximately 1% of ectopic pregnancies [1]. It carries a high risk for maternal morbidity and mortality. Many different locations at different gestational ages have been reported in the literature, including the pouch of Douglas, pelvic sidewall, bowel, broad ligament, omentum, and spleen [2-4]. These varied locations and the rarity of this type of pregnancy make diagnosis and treatment challenging. The location of the growing fetal tissue may endanger the patient's life if it impinges on vital anatomic structures. In the present case, the gestational sac was very close to the right ureter, and we opted to surgically excise the gestational sac in its entirety.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel (all authors), and the Faculty of Health Sciences, Ben-Gurion University, Beersheba, Israel (Dr. Barel).. Electronic address: oshrib@assuta.co.il.Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel (all authors), and the Faculty of Health Sciences, Ben-Gurion University, Beersheba, Israel (Dr. Barel).Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel (all authors), and the Faculty of Health Sciences, Ben-Gurion University, Beersheba, Israel (Dr. Barel).Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Israel (all authors), and the Faculty of Health Sciences, Ben-Gurion University, Beersheba, Israel (Dr. Barel).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30639318

Citation

Barel, Oshri, et al. "Laparoscopic Removal of an Abdominal Pregnancy in the Pelvic Sidewall." Journal of Minimally Invasive Gynecology, vol. 26, no. 6, 2019, pp. 1007-1008.
Barel O, Suday RR, Stanleigh J, et al. Laparoscopic Removal of an Abdominal Pregnancy in the Pelvic Sidewall. J Minim Invasive Gynecol. 2019;26(6):1007-1008.
Barel, O., Suday, R. R., Stanleigh, J., & Pansky, M. (2019). Laparoscopic Removal of an Abdominal Pregnancy in the Pelvic Sidewall. Journal of Minimally Invasive Gynecology, 26(6), pp. 1007-1008. doi:10.1016/j.jmig.2018.12.020.
Barel O, et al. Laparoscopic Removal of an Abdominal Pregnancy in the Pelvic Sidewall. J Minim Invasive Gynecol. 2019;26(6):1007-1008. PubMed PMID: 30639318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic Removal of an Abdominal Pregnancy in the Pelvic Sidewall. AU - Barel,Oshri, AU - Suday,Ramy Rahamim, AU - Stanleigh,Jonathan, AU - Pansky,Moty, Y1 - 2019/01/09/ PY - 2018/12/17/received PY - 2018/12/26/accepted PY - 2019/1/15/pubmed PY - 2019/1/15/medline PY - 2019/1/15/entrez KW - Abdominal pregnancy KW - Ectopic pregnancy KW - Laparoscopy SP - 1007 EP - 1008 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 26 IS - 6 N2 - STUDY OBJECTIVE: To describe the presentation, diagnosis, and management of a patient with abdominal pregnancy and to illustrate the laparoscopic technique used to manage this patient. DESIGN: A descriptive study approved by our local Institutional Review Board. Consent was given from the patient. SETTING: A university hospital in Ashdod, Israel. PATIENT: On May 15th 2018, a gravida 3, para 2, 37-year-old asymptomatic patient was referred to our hospital's gynecologic emergency department due to a suspected ectopic pregnancy. The patient had no relevant medical or surgical history. Her obstetric history consisted of 2 spontaneous vaginal deliveries with no other significant gynecologic history. Her menses were regular every month. Her last menstrual period was 6 weeks before presentation. Her β-human chorionic gonadotropin (hCG) level measured on the day before presentation was 24,856 IU/L. Physical examination was unremarkable except for a small amount of brownish vaginal discharge. A transvaginal ultrasound (TVUS) exam on presentation did not demonstrate an intrauterine gestational sac, but revealed a gestational sac and a fetus next to the right adnexa, with a crown-rump length of 1.3 cm, consistent with 7+3 gestational weeks. There was a minimal amount of fluid in the pouch of Douglas. INTERVENTION: Owing to an extrauterine pregnancy with high β-hCG value, laparoscopic operative management was chosen. On entrance to the abdominal cavity, a normal uterus and 2 ovaries and fallopian tubes were observed. A small to moderate amount of blood was present in the pouch of Douglas. a 3- to 4-cm distension was noted over the right uterosacral ligament. Following delicate probing of the area, moderate to severe bleeding commenced, which was initially controlled with local pressure and oxidized regenerated cellulose. An intraoperative TVUS identified an abdominal pregnancy in the right pelvic sidewall. The gestational sac was completely dissected and removed following ureterolysis and separation of the right ureter from the specimen. Local injection of vasopressin was also used. The β-hCG level before surgery of 19,008 IU/L decreased to 6339 IU/L on postoperative day 1. The patient was discharged in good condition on postoperative day 2. A final histopathological report confirmed a gestational sac. MEASUREMENT AND MAIN RESULTS: This patient referred for a tubal ectopic pregnancy was eventually diagnosed with an abdominal pregnancy and was treated operatively with complete excision of the abdominal pregnancy, which was located at the right pelvic sidewall. CONCLUSION: Abdominal pregnancy is a rare type of ectopic pregnancy with a reported incidence of 1:10,000 to 1:30,000 pregnancies, and accounts for approximately 1% of ectopic pregnancies [1]. It carries a high risk for maternal morbidity and mortality. Many different locations at different gestational ages have been reported in the literature, including the pouch of Douglas, pelvic sidewall, bowel, broad ligament, omentum, and spleen [2-4]. These varied locations and the rarity of this type of pregnancy make diagnosis and treatment challenging. The location of the growing fetal tissue may endanger the patient's life if it impinges on vital anatomic structures. In the present case, the gestational sac was very close to the right ureter, and we opted to surgically excise the gestational sac in its entirety. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/30639318/Laparoscopic_Removal_of_an_Abdominal_Pregnancy_in_the_Pelvic_Sidewall L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(19)30006-8 DB - PRIME DP - Unbound Medicine ER -