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Case Reports
. 2025 Mar 30;56(1):e5005576.
doi: 10.25100/cm.v56i1.5576. eCollection 2025 Jan-Mar.

Laparoscopic surgical alternative in the treatment of ruptured cornual heterotopic pregnancy

Enrique Herrera Castañeda  1 , Gustavo Luna  2 , Jessica Sejnaui Sayegh  1 , Luisa M Vacca Orrego  1 , Juan Manuel Tobar Parra  1
Affiliations
Case Reports

Laparoscopic surgical alternative in the treatment of ruptured cornual heterotopic pregnancy

Enrique Herrera Castañeda et al. Colomb Med (Cali). .

Abstract
in English, Spanish

Case description: A 35-year-old woman with a history of intrauterine device use for family planning presented with a spontaneously conceived heterotopic pregnancy.

Clinical findings: The patient developed a ruptured cornual ectopic pregnancy, leading to hemodynamic instability and an acute abdomen, while concurrently carrying a viable intrauterine pregnancy.

Treatment and outcome: A laparoscopic intervention was performed to manage the ruptured ectopic pregnancy. The surgical technique employed minimized the impact on maternal blood volume, ensuring patient stabilization and favorable progression of the intrauterine pregnancy.

Clinical relevance: Heterotopic pregnancy is the coexistence of gestation in two different implantation sites, both intrauterine and extrauterine. This condition is associated with significant maternal morbidity and mortality. Management remains a challenge due to the lack of consensus and limited clinical experience. The primary goal is maternal stabilization while preserving the intrauterine pregnancy whenever possible. This case highlights the importance of modern surgical strategies tailored to optimize maternal and fetal outcomes.

Descripción del Caso:: Mujer de 35 años con antecedente de uso de dispositivo intrauterino para planificación familiar, quien presentó un embarazo heterotópico concebido de manera espontánea.

Hallazgos Clínicos:: La paciente desarrolló un embarazo ectópico cornual roto, con inestabilidad hemodinámica y abdomen agudo, asociado a un embarazo intrauterino viable.

Tratamiento y Evolución:: Se realizó una intervención laparoscópica para el manejo del embarazo ectópico roto. La técnica quirúrgica utilizada minimizó el impacto en la volemia materna, permitiendo la estabilización de la paciente y la evolución favorable del embarazo intrauterino.

Relevancia Clínica:: El embarazo heterotópico es la coexistencia de una gestación en dos sitios de implantación diferentes, tanto intrauterino como extrauterino. Esta condición está asociada con una morbilidad y mortalidad materna significativas. El manejo representa un desafío debido a la falta de consensos y a la experiencia clínica limitada. El objetivo principal es la estabilización materna, con la intención de preservar el embarazo intrauterino cuando sea posible. Este caso resalta la importancia de estrategias quirúrgicas actuales adaptadas para optimizar los resultados maternos y fetales

Keywords: Heterotopic pregnancy; ectopic pregnancy; laparoscopy.

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Figures

Figure 1
Figure 1. Minimally invasive treatment. A. Ruptured cornual ectopic pregnancy with active bleeding. B. Placement of an endosuture (Vycril 1-0) through the mesosalpinx, producing vascular blockage of the tubal branch of the uterine artery. C. Resection of the cornual pregnancy with a 5-mm Ligasure to reinforce hemostasis
Figura 1
Figura 1. Tratamiento mínimo invasivo. A. Embarazo ectópico cornual roto con sangrado activo. B. Colocación de endosutura (vycril 1-0) a través del mesosalpinx produciendo bloqueo vascular de la rama Tubárica de la Arteria Uterina. C. Resección del embarazo cornual con Ligasure de 5 mm para reforzar hemostasia.
See this image and copyright information in PMC

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