1
|
You SL, Wang Y. Omentum pregnancy resulting in severe hemoperitoneum: Lessons learned from a review of the literature along with a case report. J Int Med Res 2024; 52:3000605241261893. [PMID: 39053448 PMCID: PMC11283667 DOI: 10.1177/03000605241261893] [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: 01/19/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
Abdominal pregnancies are a rare form of ectopic pregnancy with omentum pregnancies being even rarer. Ectopic pregnancy should be diagnosed and terminated early to prevent the risk of harm to the mother. This case report describes a rare case of omentum pregnancy with severe hemoperitoneum. The patient had not visited a doctor until she failed to menstruate for 3 months, by which point she had developed severe hypogastralgia. The patient was diagnosed with a ruptured ectopic pregnancy after ultrasonography. The omentum pregnancy was complicated by severe hemoperitoneum, which was confirmed by emergency laparotomy. The patient was treated successfully with fetal extraction and partial omentectomy. Ultrasound examination in early pregnancy is essential to detect and treat ectopic pregnancies as early as possible, as surgery is usually required for abdominal pregnancies. Prompt treatment of ectopic pregnancies is critical, as an omentum pregnancy is dangerous and may result in severe intraperitoneal bleeding.
Collapse
Affiliation(s)
- Shu-Li You
- Department of Gynaecology and Obstetrics, The People's Hospital of Wucheng District, Jinhua City, Zhejiang Province, China
| | - Yu Wang
- Department of Gynaecology and Obstetrics, The People's Hospital of Wucheng District, Jinhua City, Zhejiang Province, China
| |
Collapse
|
2
|
Surgontaitė D, Sukovas A, Railaitė DR, Jankauskas T, Bartusevičius A, Bartusevičienė E. Trophoblastic Tissue Reimplantation below the Spleen Following Laparoscopic Bilateral Salpingectomy for Ectopic Tubal Pregnancy: A Case Report. Medicina (B Aires) 2023; 59:medicina59040701. [PMID: 37109659 PMCID: PMC10143170 DOI: 10.3390/medicina59040701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Trophoblastic tissue reimplantation after laparoscopic salpingectomy is a very rare complication. These cases may present a diagnostic challenge and the majority of patients need a surgical treatment. Case presentation: A 31-year-old patient came to a tertiary referral center for nausea and pain in the upper left abdominal quadrant. Ultrasound and abdominal CT scan showed a 68 × 60 × 87 mm size heterogenic mass below the spleen with arterial extravasation from the lower spleen pole. Recent history of surgery for ectopic pregnancy and serum hCG testing allowed to diagnose extratubal secondary trophoblastic tissue reimplantation below the spleen. Embolization of the bleeding vessel and successful treatment with methotrexate was achieved. Conclusions: In cases of a nondisseminated trophoblastic tissue reimplantation, consider embolization and treatment with methotrexate if the patient is hemodynamically stable; thus, secondary surgical treatment is preventable.
Collapse
Affiliation(s)
- Dominyka Surgontaitė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Artūras Sukovas
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Dalia Regina Railaitė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Tautvydas Jankauskas
- Department of Interventional Radiology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Arnoldas Bartusevičius
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Eglė Bartusevičienė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| |
Collapse
|
3
|
Suleiman R, Adwan D, Safadi MF. Ectopic abdominal pregnancy on the ascending colon. Clin Case Rep 2022; 10:e6581. [DOI: 10.1002/ccr3.6581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Riham Suleiman
- Department of Obstetrics and Gynaecology Maternity University Hospital Damascus Syria
| | - Dema Adwan
- Department of Obstetrics and Gynaecology Maternity University Hospital Damascus Syria
| | - Mhd Firas Safadi
- Department of General Surgery, Visceral Surgery, and Proctology Diakonie Hospital Hartmannsdorf Germany
| |
Collapse
|
4
|
Trail CE, Watson A, Schofield AM. Case of hepatic flexure ectopic pregnancy medically managed with methotrexate. BMJ Case Rep 2018; 2018:bcr-2017-220480. [PMID: 29550756 PMCID: PMC5878386 DOI: 10.1136/bcr-2017-220480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/03/2022] Open
Abstract
Abdominal pregnancies represent 1.4% of extrauterine pregnancies. A literature search of six cases involving bowel ectopic pregnancies provided anecdotal treatment options. This case involves a woman admitted at 6 weeks gestation with right iliac fossa and shoulder tip pain. An ultrasound scan revealed an empty uterus with free fluid in both adnexa and a 31×21 mm heterogenous mass adjacent to the right ovary. At laparoscopy, an ectopic pregnancy was identified at the hepatic flexure. The patient received two doses of methotrexate and monitored until the beta human chorionic gonadotropin reduced. The decision to manage with methotrexate was balanced against reported cases of bowel perforation and the possibility that a section of bowel may need removal if the pregnancy showed signs of invasion. Maternal mortality rate with abdominal pregnancy is 20% due to the risk of massive haemorrhage from placental separation or invasion of bowel vasculature. Medical treatment here was successful and avoided extensive surgery.
Collapse
Affiliation(s)
| | - Andrew Watson
- Department of Obstetrics and Gynaecology, Tameside NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Alice Martha Schofield
- Department of Obstetrics and Gynaecology, Tameside NHS Foundation Trust, Ashton-under-Lyne, UK
| |
Collapse
|
5
|
Abstract
We present a case of primary omental ectopic pregnancy in a 31-year-old woman which was discovered intraoperatively during a diagnostic laparoscopy and subsequently removed via mini-laparotomy. We emphasise the rarity of this diagnosis, and the importance of careful inspection of the abdominal cavity including the omentum should an ectopic pregnancy be suspected when bilateral fallopian tubes and ovaries appear normal during surgical exploration.
Collapse
Affiliation(s)
- Swee Lin Yip
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.,Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - Wei Keat Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - Lay Kok Tan
- Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
6
|
Chen L, Qiu L, Diao X, Yue Q, Gong Q. CT findings of omental pregnancy: a case report. Jpn J Radiol 2015; 33:499-502. [PMID: 26111878 DOI: 10.1007/s11604-015-0449-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/16/2015] [Indexed: 02/05/2023]
Abstract
Omental pregnancy is an extremely rare and dangerous form of ectopic pregnancy which can be very difficult to diagnose radiologically. We report the case of an 18-year-old girl with secondary omental pregnancy who was assessed by use of contrast-enhanced computed tomography (CT). For the first time, we report the contrast-enhanced CT features of omental pregnancy. Inhomogeneous mild enhancement was observed, which is different from other kinds of ectopic pregnancy, for which enhancement is often substantial. Possible reasons for the discrepancy are discussed, as also is differential diagnosis of omental pregnancy.
Collapse
Affiliation(s)
- Lizhou Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, People's Republic of China
| | | | | | | | | |
Collapse
|
7
|
Miyauchi A, Yamada M, Furuya M, Matsumura S, Murayama S, Yoshimura Y, Tanaka M. Peritoneal pregnancy with massive hemoperitoneum in early gestation: two case reports. Clin Case Rep 2015; 3:431-7. [PMID: 26185643 PMCID: PMC4498857 DOI: 10.1002/ccr3.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/21/2014] [Accepted: 02/20/2015] [Indexed: 11/09/2022] Open
Abstract
Peritoneal pregnancy may cause severe abdominal bleeding without genital bleeding as early as the fifth week of gestation. Awareness that pregnancy can exist in unusual locations is imperative.
Collapse
Affiliation(s)
- Azumi Miyauchi
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mitsutoshi Yamada
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masataka Furuya
- Department of Obstetrics and Gynecology, Eiju General Hospital 2-23-16 Higashiueno, Taito-ku, Tokyo, 110-0015, Japan
| | - Satoko Matsumura
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinji Murayama
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Yoshimura
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
8
|
Watrowski R, Lange A, Möckel J. Primary omental pregnancy with secondary implantation into posterior cul-de-sac: laparoscopic treatment using hemostatic matrix. J Minim Invasive Gynecol 2014; 22:501-3. [PMID: 24973638 DOI: 10.1016/j.jmig.2014.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
Primary omental pregnancy is a rare form of ectopic pregnancy. Only a few reported cases have been treated using laparoscopy. Hemostasis after trophoblast removal can be challenging. A 25-year-old primigravida in week 8 of pregnancy was admitted to our hospital with a diagnosis of missed abortion. An ultrasound scan showed an empty uterine cavity and a gestational sac with a 15-mm embryo dorsal to the uterus, indicative of an ectopic pregnancy. The preoperative serum concentration of human chorionic gonadotropin was 33 600 U/mL. Laparoscopy was performed, which revealed an omental pregnancy invading the peritoneum of the Douglas pouch. After laparoscopic removal of the ectopic pregnancy with partial omentectomy, diffuse bleeding from the crater between both sacrouterine ligaments was treated using the gelatin-thrombin matrix (FloSeal). The final histologic analysis confirmed the omentum as the primary site of the ectopic pregnancy (multiple chorionic villi and decidua within the omental fat). The postoperative period was uneventful. This case expands the classic Studdiford criteria. Secondary peritoneal ectopic pregnancy implantation can occur not only after tubal rupture or expulsion of tubal ectopic pregnancy but also after primary implantation at any other ectopic site. The laparoscopic approach to abdominal pregnancy is safe and feasible if there is sufficient intraoperative hemostasis. The hemostatic matrix facilitates quick and effective control of bleeding.
Collapse
Affiliation(s)
- Rafał Watrowski
- Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany.
| | - Annabel Lange
- Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Jochen Möckel
- Institute of Pathology "Dr. Möckel & Dr. Schneider", Freiburg, Germany
| |
Collapse
|
9
|
Neglected primary omental pregnancy after laparoscopic and medical treatment: a difficult diagnosis? Case Rep Obstet Gynecol 2013; 2013:207307. [PMID: 23819081 PMCID: PMC3684085 DOI: 10.1155/2013/207307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/21/2013] [Indexed: 11/17/2022] Open
Abstract
The following case report describes a rare case of omental pregnancy in a fertile 34-year-old woman at 5 + 3 weeks of gestation who presented with abdominal pain. Clinical examination, vital signs, and laboratory values were within normal limits, so the woman was hospitalized and monitored. Laparoscopic exploration was performed according to the preoperative diagnosis of tubal pregnancy, but it showed normal pelvic organs. In view of the growth of the β-HCG value, a medical approach was attempted, without success. Due to hemodynamic instability, an emergency laparotomy was performed, and it showed an omental pregnancy, confirmed at the pathological examination.
Collapse
|
10
|
Takeda A, Imoto S, Mori M, Yamada J, Nakamura H. Early Abdominal Pregnancy Complicated by Parasitic Dermoid Cyst: Diagnosis by Diffusion-Weighted Magnetic Resonance Imaging and Management by Laparoendoscopic Single-Site Surgery. J Minim Invasive Gynecol 2012; 19:647-50. [DOI: 10.1016/j.jmig.2012.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 03/24/2012] [Accepted: 03/29/2012] [Indexed: 11/28/2022]
|
11
|
Poole A, Haas D, Magann EF. Early Abdominal Ectopic Pregnancies: A Systematic Review of the Literature. Gynecol Obstet Invest 2012; 74:249-60. [DOI: 10.1159/000342997] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 08/23/2012] [Indexed: 11/19/2022]
|
12
|
Successful Laparoscopic Management of Early Splenic Pregnancy: Case Report and Review of Literature. J Minim Invasive Gynecol 2010; 17:794-7. [DOI: 10.1016/j.jmig.2010.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/17/2010] [Accepted: 07/03/2010] [Indexed: 11/23/2022]
|
13
|
Successful laparoscopic management of primary omental pregnancy. Arch Gynecol Obstet 2009; 281:163-5. [DOI: 10.1007/s00404-009-1100-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
|