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Durden JA, Burleson SL, Pigott DC, Gullett JP, Thompson M. Abdominal Ectopic Pregnancy: A Case Report of an Uncommon Complication of Pregnancy Without Prenatal Care. Cureus 2024; 16:e68478. [PMID: 39360090 PMCID: PMC11446606 DOI: 10.7759/cureus.68478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2024] [Indexed: 10/04/2024] Open
Abstract
Ectopic pregnancy (EP) is a life-threatening condition requiring a high clinical suspicion. This diagnosis must be considered in all female patients of reproductive age presenting with abdominal pain or discomfort who may possibly be pregnant. Ectopic pregnancies occur in a small percentage of all pregnancies and are a significant cause of maternal morbidity and mortality. Abdominal ectopic pregnancy (AEP) is a rare and potentially fatal form of ectopic pregnancy where the implantation occurs in the abdominal cavity. We present the following case of a 23-year-old female who was transferred following an initial workup for abdominal pain and subsequently found to have an abdominal ectopic pregnancy at 37 weeks gestation. After transferring to our emergency department, the patient continued to have abdominal pain and her presenting FAST exam was positive for free fluid concerning for active hemorrhage and hematoma. Her clinical presentation was consistent with ruptured abdominal ectopic pregnancy, and she was taken to the operating room for emergent exploratory laparotomy and delivery. Her clinical course was complicated by adherent placenta and re-bleeding with significant hemoperitoneum requiring re-entry laparotomy and transfusion. We present the details of this case along with the diagnostic imaging and management of the rarely seen and life-threatening condition of secondary abdominal ectopic pregnancy (AEP).
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Affiliation(s)
- James A Durden
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Samuel L Burleson
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - David C Pigott
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - John P Gullett
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Maxwell Thompson
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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Alwafai Z, Kolbe C, Kruse-Wieczorek J, Khanji MN, Zygmunt M. Challenging Diagnosis of Late Abdominal Pregnancy: A Case Study of Misdiagnosis and Fetal Death in the Third Trimester. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943625. [PMID: 38980831 PMCID: PMC11318717 DOI: 10.12659/ajcr.943625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 06/05/2024] [Accepted: 04/04/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Abdominal pregnancy is a rare form of extrauterine pregnancy that usually results in a poor outcome; it is associated with serious fetal and maternal morbidity. The diagnosis of advanced abdominal pregnancy is sometimes challenging and should be identified early, at a routine antenatal examination. There are still no evidence-based management strategies for late abdominal pregnancy. This report presents a case of a patient with an abdominal pregnancy and a non-viable fetus. CASE REPORT A 34-year-old woman presented as an emergency 2 months after the diagnosis of intrauterine fetal death at 33 weeks of gestation. During subsequent surgery, the pregnancy was found to be an undiagnosed abdominal pregnancy. The patient had been admitted due to abdominal pain and increasingly deteriorating general condition. On admission, clinical examination and abdominal ultrasound were carried out and the diagnosis of fetal death was confirmed. The diagnosis of extrauterine pregnancy, however, was initially missed, and a decision to induce labor was made. After unsuccessful induction of labor and deterioration of the patient's general condition, a laparotomy was performed, and the diagnosis of abdominal pregnancy was confirmed. A severely macerated fetus and placenta were delivered. Relative to others with this condition, the patient had a very good postoperative outcome with prolonged healing of the surgical incision. Informed consent for publication was obtained from the patient. CONCLUSIONS The diagnosis of late abdominal pregnancy can be missed despite clinical and sonographic examination. This diagnosis should be considered and excluded in similar suspected clinical findings. Proper operative planning in a tertiary center with a well-experienced team is crucial.
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Affiliation(s)
- Zaher Alwafai
- Department of Obstetrics and Gynecology, University of Greifswald, Greifswald, Germany
| | - Claudia Kolbe
- Department of Obstetrics and Gynecology, University of Greifswald, Greifswald, Germany
| | - Judith Kruse-Wieczorek
- Department of Obstetrics and Gynecology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Mohammad Nour Khanji
- Department of Obstetrics and Gynecology, University of Greifswald, Greifswald, Germany
| | - Marek Zygmunt
- Department of Obstetrics and Gynecology, University of Greifswald, Greifswald, Germany
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Pham TH, Bui VH, Nguyen VH, Nguyen PN. Ectopic pregnancy located at pelvic wall and liver: Two uncommon case reports from Vietnam and mini-review literature. Int J Surg Case Rep 2024; 118:109603. [PMID: 38642432 PMCID: PMC11046073 DOI: 10.1016/j.ijscr.2024.109603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal ectopic pregnancy (AEP) located at hepatic region and pelvic-wall ectopic pregnancy (EP) are rare entities, that provoking a potentially life-threatening condition. Due to insufficient data, a proper management of non-specific types remains a challenge for all gynecologists worldwide. CASE PRESENTATION Two child-bearing age women were hospitalized due to delayed menstruation and a urine pregnancy test was positive without a determination of intrauterine pregnancy. The first EP case was located at the pelvic wall which identified incidentally during laparoscopy for a presumed tubal ectopic pregnancy on ultrasonography throughout. The second EP case was found at the hepatic region due to intermittent pain rising from the right upper quadrant region and serial ultrasonic findings. In our management, both cases were successfully assessed by laparoscopy and laparotomy without requiring further intervention, respectively. CLINICAL DISCUSSION An accurate diagnosis of EP location at liver and pelvic wall is totally difficult since its uncommon location. An initial assessment should be based on clinical symptoms and the treatment remains controversial. The surgical management including laparotomy and laparoscopy depends on clinical evaluation, experience of surgeon, and interdisciplinary team. Thus, these abnormal sites of ectopic pregnancy ought to take into consideration for all gynecologists in an emergency condition with a major hemorrhage. CONCLUSIONS In reproductive age women, primary EP at liver and pelvic wall should be considered with high index of suspicion if intrauterine pregnancy is totally excluded. Timely diagnosis, rational management by surgical excision, and a multidisciplinary team can reduce substantially adverse outcomes.
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Affiliation(s)
- Thanh Hai Pham
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Viet Nam
| | - Van Hoang Bui
- Integrated Planning Department, Tu Du Hospital, Ho Chi Minh City, Viet Nam
| | - Van Hung Nguyen
- Department of Gynecology, Tu Du Hospital, Ho Chi Minh City, Viet Nam
| | - Phuc Nhon Nguyen
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Viet Nam; Department of High-risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Viet Nam.
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Christian-Bardol KK, Patrick EM, Chama SB, Noe KM, Musa MS, Fabrice LM. Challenges and perspectives of abdominal pregnancy in a resource-limited setting: A case series. Int J Surg Case Rep 2024; 115:109282. [PMID: 38306869 PMCID: PMC10847145 DOI: 10.1016/j.ijscr.2024.109282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal pregnancies, although rare, present unique challenges in both diagnosis and management. This case series reports on four cases of abdominal pregnancies diagnosed in a remote and underserved region of the Democratic Republic of Congo, highlighting the difficulties encountered in an under-equipped environment. CASE PRESENTATION The cases were documented in a remote village of DRC, which lacks specialized medical personnel and relies heavily on traditional healers. We report here 4 cases of abdominal pregnancies, their clinical presentations, diagnostic modalities, and surgical approaches. The cases varied in terms of clinical symptoms, gestational age, and placental implantation sites. Delayed diagnosis and presentation were common, resulting in significant hemoperitoneum and adverse fetal outcomes. All cases required laparotomy for both diagnosis and intervention. CLINICAL DISCUSSION Abdominal pregnancies can go undetected until advanced gestational age, with common physical findings including abdominal tenderness, abnormal fetal lie, fetal body parts readily palpable, and a displaced cervix. Laboratory tests may raise suspicion, but treatment options depend on intraoperative findings and gestational age. Advanced abdominal pregnancies are associated with high mortality rates for both the mother and the fetus. Laparotomy is typically required for diagnosis and intervention, with variations in placental implantation sites. Management of the placenta remains a debated topic, with partial or complete removal both viable options. CONCLUSION Abdominal pregnancies pose significant challenges in resource-poor settings, where limited healthcare resources and a shortage of specialized medical personnel can impede early diagnosis and appropriate management. Enhancing prenatal care, improving diagnostic capabilities, and increasing awareness among healthcare providers and communities are essential for optimizing outcomes in these complex obstetric cases.
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Affiliation(s)
| | - Ekinda Mbula Patrick
- General medicine, Saint Luc Reference Health Center, Lukafu, Haut katanga, the Democratic Republic of the Congo
| | - Syrile Bwalya Chama
- General medicine, Saint Luc Reference Health Center, Lukafu, Haut katanga, the Democratic Republic of the Congo; Central Office of the Health Zone of Lukafu, Haut Katanga, the Democratic Republic of the Congo
| | - Kasereka Mwanamolo Noe
- Department of Obstetrics and Gynecology, National University Hospital Hubert Koutoukou Maga, Cotonou, Benin
| | - Maria Sumayi Musa
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Lele Mutombo Fabrice
- Department of General Surgery, Heal Africa Hospital, Goma, the Democratic Republic of the Congo.
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Minis E, Fitz V, Petrozza JC. Laparoscopic management of omental ectopic pregnancy: lessons to be learned from a rare case. Fertil Steril 2024; 121:259-260. [PMID: 38065471 DOI: 10.1016/j.fertnstert.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/31/2023]
Affiliation(s)
- Evelyn Minis
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria Fitz
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John C Petrozza
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Magezi J, Wacha J, Pebalo PF. Chronicles of an uncommon term abdominal pregnancy with successful outcome: a case report. J Med Case Rep 2024; 18:61. [PMID: 38263126 PMCID: PMC10807207 DOI: 10.1186/s13256-023-04312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2 + 1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the significance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. CASE PRESENTATION A 25 year African black female, para 2 + 1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The postoperative course was uneventful, with initial concerns about inadequate breast milk flow which resolved after placental removal during the second exploratory laparotomy. CONCLUSION This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings.
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Affiliation(s)
| | - Joshua Wacha
- Gulu Regional Referral Teaching Hospital, Gulu, Uganda
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Dunphy L, Boyle S, Cassim N, Swaminathan A. Abdominal ectopic pregnancy. BMJ Case Rep 2023; 16:e252960. [PMID: 37775278 PMCID: PMC10546113 DOI: 10.1136/bcr-2022-252960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
An ectopic pregnancy (EP) accounts for 1-2% of all pregnancies, of which 90% implant in the fallopian tube. An abdominal ectopic pregnancy (AEP) is defined as an ectopic pregnancy occurring when the gestational sac is implanted in the peritoneal cavity outside the uterine cavity or the fallopian tube. Implantation sites may include the omentum, peritoneum of the pelvic and abdominal cavity, the uterine surface and abdominal organs such as the spleen, intestine, liver and blood vessels. Primary abdominal pregnancy results from fertilisation of the ovum in the abdominal cavity and secondary occurs from an aborted or ruptured tubal pregnancy. It represents a very rare form of an EP, occurring in <1% of cases. At early gestations, it can be challenging to render the diagnosis, and it can be misdiagnosed as a tubal ectopic pregnancy. An AEP diagnosed >20 weeks' gestation, caused by the implantation of an abnormal placenta, is an important cause of maternal-fetal mortality due to the high risk of a major obstetric haemorrhage and coagulopathy following partial or total placental separation. Management options include surgical therapy (laparoscopy±laparotomy), medical therapy with intramuscular or intralesional methotrexate and/or intracardiac potassium chloride or a combination of medical and surgical management. The authors present the case of a multiparous woman in her early 30s presenting with heavy vaginal bleeding and abdominal pain at 8 weeks' gestation. Her beta-human chorionic gonadotropin (bHCG) was 5760 IU/L (range: 0-5), consistent with a viable pregnancy. Her transvaginal ultrasound scan suggested an ectopic pregnancy. Laparoscopy confirmed an AEP involving the pelvic lateral sidewall. Her postoperative 48-hour bHCG was 374 IU/L. Due to the rarity of this presentation, a high index of clinical suspicion correlated with the woman's symptoms; bHCG and ultrasound scan is required to establish the diagnosis to prevent morbidity and mortality.
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Affiliation(s)
- Louise Dunphy
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Stephanie Boyle
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Nadia Cassim
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Ajay Swaminathan
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
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Mulisya O, Barasima G, Lugobe HM, Matumo P, Vahwere BM, Mutuka H, Léocadie Z, Lumika W. Abdominal pregnancy with a live newborn in a low-resource setting: A case report. Case Rep Womens Health 2023; 37:e00480. [PMID: 36683781 PMCID: PMC9845762 DOI: 10.1016/j.crwh.2023.e00480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Abdominal pregnancy is defined as pregnancy anywhere within the peritoneal cavity, exclusive of tubal, ovarian, or broad ligament locations. It is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be frequently missed in low-resource settings because of poor antenatal healthcare provision, low socioeconomic patient status as well as lack of adequate medical resources. Clinical diagnosis can be difficult and ultrasound scan is helpful during the early stages of gestation but can be disappointing thereafter. A case of abdominal pregnancy in a 25-year-old woman, who presented at 26 weeks of gestation with severe abdominal pain not relieved by any medication, is reported. An emergency laparotomy was undertaken as her vital signs deteriorated. An abdominal pregnancy was found and a live neonate delivered. Ministries of health in developing countries should ensure routine access to ultrasound in early pregnancy. Obstetricians should bear in mind that abdominal pregnancy can present late in gestation.
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Affiliation(s)
- Olivier Mulisya
- Department of Gynecology and Obstetrics, Fepsi hospital, Butembo, Democratic Republic of the Congo,Corresponding author at: Department of Gynecology and Obstetrics, FEPSI hospital, Butembo, Democratic Republic of the Congo.
| | - Guelord Barasima
- Department of Gynecology and Obstetrics, La Breche Medical Center, 00243 La Breche, BENI, Democratic Republic of the Congo
| | - Henry Mark Lugobe
- Department of Gynecology and Obstetrics, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara Uganda, Uganda
| | - Philémon Matumo
- Département de Gynécologie Obstétrique, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Bienfait Mumbere Vahwere
- Surgery Department of Kampala International University, Box 20000, Gbaba Road, kansanga, kampala, Uganda
| | - Hilaire Mutuka
- Département de chirurgie, Institut de Technique Médical, Butembo, Democratic Republic of the Congo
| | - Zawadi Léocadie
- Department of Gynecology and Obstetrics, La Breche Medical Center, 00243 La Breche, BENI, Democratic Republic of the Congo
| | - Wesley Lumika
- Department of Gynecology and Obstetrics, La Breche Medical Center, 00243 La Breche, BENI, Democratic Republic of the Congo
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