Laparoscopic management of early primary peritoneal pregnancy: a case report

Abstract

Peritoneal pregnancy is an implantation in the peritoneal cavity exclusive of tubal, ovarian, or intra-ligamentary implantations. This is a rare obstetric complication with high maternal mortality and even higher perinatal mortality, and secondary type was most common. Risk factors for peritoneal pregnancy are previous history of extrauterine pregnancy or tubal surgery pelvic post-inflammatory status or presence of an intra-uterine device. As it is a life-threatening condition, expectant management carries a risk of sudden life-threatening intra-abdominal bleeding and a generally poor fetal prognosis. So, when it is recognized, immediate termination of pregnancy is usually recommended. Early diagnosis of peritoneal pregnancy is difficult, but is important by their life threatening progress course to patients. Recently, we experienced primary peritoneal pregnancy which meets both the original and modified criteria. In this paper, we reported the case of early diagnosed and successfully treated peritoneal pregnancy despite of their diagnosis was incidentally.

Keywords: Ectopic Pregnancy; Human; Laparoscopic Management; Primary Peritoneal Pregnancy.

Figure 1

Transvaginal ultrasound findings at amenorrhea 5⁺¹ weeks which suggested extra-uterine pregnancy in the left adnexa. (A) A hyper-echoic mass was detected in the lateral aspect of the left ovary. (B) A gestational sac-like structure was detected in the left ovarian hyper-echoic mass.

Figure 2

Laparoscopic findings of initial operation. A reddish and edematous mass on the left infundibulopelvic ligament was detected on laparoscopic examination.

Figure 3

Pathologic findings of excised masses from the initial operation. (A) Cystic mass on the left ovary: lutenized cells with abundant eosinophilic to clear cytoplasm lined cyst (left side) and lie within its fibrous wall (right side) (H&E stain, ×200). (B) Reddish nodular mass on the infundibulopelvic ligament: three cortical layers resembling adrenal glands without medullary tissue (H&E stain, ×40).

Figure 4

Transvaginal ultrasound findings at 5 days after MTX injection, which corresponded to post-operative 6 days and amenorrhea 6⁺⁰ weeks. (A) An echogenic mass was noted in the left adnexa lateral to the left ovary. (B) An inner gestational sac-like structure and 0.2-cm sized yolk sac-like structure with fetal heart movement.

Figure 5

Laparoscopic findings of re-operation. A reddish mass was detected at the pelvic peritoneum, which was located in the cul-de-sac area adjacent to the lateral aspect of the left utero-sacral ligament.

Figure 6

Pathologic findings of excised pelvic peritoneal mass and salpingectomy specimen at re-operation. (A) Pelvic peritoneal mass: degenerated villous trophoblasts, consistent with ectopic pregnancy (H&E stain, ×100). (B) Salpingectomy specimen: infiltrated chronic inflammatory cells and hemorrhagic congestion (H&E stain, ×100).