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. 2010 Dec 1;11(4):220-2.
doi: 10.5152/jtgga.2010.42. eCollection 2010.

Laparoscopic management of primary abdominal pregnancy: a case report

Mehmet Metin Altay  1 , Betül Dündar  1 , Ahmet Okyar Erol  1 , Volkan Kurtaran  1 , Orhan Gelişen  1
Affiliations

Laparoscopic management of primary abdominal pregnancy: a case report

Mehmet Metin Altay et al. J Turk Ger Gynecol Assoc. .

Abstract
in English, Turkish

This is a case report of a primary abdominal pregnancy managed by laparoscopic intervention. A 22 year old, gravida 1, woman was admitted to our emergency room with vaginal bleeding and pain in lower abdomen. She was 4 weeks pregnant according to her last menstrual period. She had undergone right salpingoophorectomy previously. Pelvic examination revealed cervical motion tenderness, bilateral adnexal tenderness and rebound tenderness. Her vital signs were normal. Beta hCG was 15826 IU/ml and hemoglobin was 10.0 g/dl. Transvaginal sonography showed an endometrium of 3 mm thickness and free fluid in the pelvis. Upon admission to the Early Pregnancy Clinic, abdominal pain became worse and hemoglobin decreased to 8.0 g/dL. Therefore, we performed a laparoscopy which showed that the uterus, left tube and ovary were completely normal with absence of the right ovary and tube. Approximately 500 cc blood was aspirated from the pelvis. Between the right sacrouterine ligament and rectum, there was a bleeding area 2 cm in width which was removed with forceps and sent for frozen pathological examination,which revealed 'placental tissue fragments'. Endometrial sampling was reported to be 'secretory endometrium'. A rapid decrease in the beta HCG post operative titer confirmed the resolution of the pregnancy. Primary abdominal pregnancy is extremely rare. The diagnosis is confirmed according to Studdiford's criteria. In the literature, there only a few cases of abdominal pregnancy in which laparoscopic procedure has been used effectively as treatment. However, laparoscopic procedure is usually successful in treatment of abdominal pregnancy if the gestational age is early enough.

Kliniğimizde laparoskopik olarak tedavi edilen bir primer abdominal gebelik olgusunu sunduk. 22 yaşında, gravida 1 olan hasta acil servise vajinal kanama ve alt abdominal ağrı yakınmasıyla başvurdu. Son adet tarihine göre yaklaşık 4 haftalık gebe olduğu ve daha önce tuboovaryan torsiyon tanısıyla sağ salpingoooferektomi yapıldığı öğrenildi. Pelvik muayenede serviks hareketleri ağrılıydı, bilateral adneksal hassasiyet ve rebound mevcuttu. Vital bulguları stabildi. Beta-hCG: 15826 IU/mL, Hb: 10.0 g/dL idi. Transvajinal ultrasonografide pelviste yaygın sıvı vardı, endometrium kalınlığı 3 mm, intrauterin ve/veya ektopik gebelik izlenmiyordu. Erken Gebelik Kliniği’ne kabulünde hastanın karın ağrısı arttı, Hb: 8.0 g/dL ye düştü. Hastaya intraabdominal kanama tanısıyla laparoskopik cerrahi uygulandı. Laparoskopide sağ over ve sağ tubanın cerrahi yokluk halinde olduğu izlendi. Uterus, sol over ve sol tuba normal görünümdeydi. Douglas boşluğundan yaklaşık 500 cc kan aspire edildi. Sağ sakrouterin ligament ile rektum arasında 2 cm genişliğinde kanamalı alan izlendi ve çıkarıldı. Doku örneği frozen incelemeye gönderildi, sonuç plasental doku parçaları olarak bildirildi. Aynı anda yapılan endometrial örnekleme sonucu sekretuar endometrium olarak rapor edildi. Post operatif dönemde beta-hCG değerlerinde hızlı bir düşüş izlendi. Primer abdominal gebelik son derece nadirdir. Tanı, Studdiford kriterleri ile konur. Literatürde laparoskopik cerrahinin abdominal gebelik tedavisinde etkin bir şekilde kullanıldığı olgu sayısı oldukça azdır, ancak, gebelik haftasının erken olduğu uygun vaka grubunda başarı oldukça yüksektir.

Keywords: Primary abdominal pregnancy; ectopic pregnancy; laparoscopic surgery.

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Figures

Figure 1
Figure 1
Primary abdominal pregnancy located next to the right sacrouterine ligament in the pouch of Douglas
See this image and copyright information in PMC

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