Abstract:
OBJECTIVE:To illustrate the laparoscopic surgical management of a particular localization of extrauterine pregnancy misdiagnosed until 12 weeks gestational age, complicated by hemoperitoneum and abortion. DESIGN:Canadian Task Force III on the Periodic Health Examination's Levels of Evidence. SETTING:The prevalence of ectopic pregnancy among women presenting to an emergency department with first trimester bleeding, pain, or both ranges from 1% to 16% [1]. The most common localization of ectopic pregnancy is the fallopian tubes, whereas abdominal pregnancy accounts for at least 1% of extrauterine pregnancies. The reported incidence of abdominal pregnancy ranges from 1:10 000 to 1:30 000 pregnancies [2]. Abdominal pregnancy can be localized in the pelvic cul-de-sac, broad ligament, bowel, or pelvic sidewall. This rare type of ectopic pregnancy is often misdiagnosed until later in pregnancy, evolving in hemoperitoneum, abortion, embolism, or rarely, in diagnosed cases, live birth by cesarean section. In the literature, it is recommended that the placenta be left in situ in cases of abdominal pregnancy to avoid hemorrhage and organ injury, even though this approach may be associated with a higher rate of postoperative complications, such as infection, secondary bleeding, and cancer transformation [3]. We present a case of abdominal pregnancy in which the gestational sac was implanted in the broad ligament and resulted in hemoperitoneum at 12 weeks gestational age. INTERVENTION:In August 2010, a 35-year-old woman, gravida 3 para 1, presented at the Di Meglio ultrasound diagnostic center in Naples for a noninvasive prenatal ultrasound (bi-test) to confirm gestational age in what to that point had been considered a normal pregnancy at 12 weeks gestation. Ultrasound revealed an ectopic abdominal pregnancy with a live fetus located in the left parauterine side. A suspicious fluid level in the pouch Douglas was also detected, and so the woman was advised to go to an obstetric hospital for a medical evaluation of the clinical situation (starting hemoperitoneum). Later that same day, the woman presented at the Villa dei Platani Hospital in Avellino, where ultrasound confirmed increased fluid in the pouch of Douglas, along with initial signs of hemoperitoneum and loss of the fetal heartbeat. The woman was immediately transferred to the Malzoni Center for Advanced Endoscopic Gynecological Surgery in Avellino, where she underwent operative laparoscopy for removal of the abdominal pregnancy (surgeon, M.M.). Informed consent for the laparoscopic surgery was provided by the patient in accordance with local regulations. The patient also provided informed consent for the use of images and a video of the procedure. Institutional Review Board approval was not required. The procedure involved laparoscopic hemoperitoneum drainage (at least 500 mL of blood), left adnexectomy after transperitoneal identification of the left uretheral pathway, and complete removal of left broad ligament pregnancy abortion with consensual removal of the ectopic placenta. CONCLUSION:The laparoscopic management of abdominal pregnancy and hemoperitoneum resulting from rupture of the gestational chamber and abortion was optimal. With this minimally invasive technique, it was possible to drain the hemoperitoneum completely and then proceed to total removal of the gestational chamber and the fetus. Thanks to the magnification of the image by laparoscopy, it was also possible to completely remove the placenta and the cotyledons from the peritoneal surface, thereby avoiding possible postoperative bleeding, infection, and sepsis resulting from retention of incomplete removal of the placenta. On the first postoperative day, the patient was in excellent clinical condition, with a marked reduction in circulating β-human chorionic gonadotropin. She was discharged on the second postoperative day and currently is in good health.
journal_name
J Minim Invasive Gynecoljournal_title
Journal of minimally invasive gynecologyauthors
Cosentino F,Rossitto C,Turco LC,Gueli Alletti S,Vascone C,Di Meglio L,Scambia G,Malzoni Mdoi
10.1016/j.jmig.2017.01.023subject
Has Abstractpub_date
2017-01-01 00:00:00pages
724-725issue
5eissn
1553-4650issn
1553-4669pii
S1553-4650(17)30099-7journal_volume
24pub_type
杂志文章abstract:STUDY OBJECTIVE:Cervical cancer is a significant health problem in countries of the developing world. Although case series suggest advantages of total laparoscopic radical hysterectomy (TLRH) compared with total abdominal radical hysterectomy (TARH), no randomized controlled trial is currently available to establish TL...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jmig.2008.06.013
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Transvaginal surgery is the most minimally invasive surgery for a gynecologic procedure but can be challenging for many to perform as evidenced by its declining rate. Vaginal removal of the adnexal structures can be difficult because of poor visualization. Factors such as abnormal pathology, incidental findi...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2018.01.028
更新日期:2018-01-01 00:00:00
abstract:STUDY OBJECTIVE:To identify the characteristics of uterine sarcomas and assess the impact of morcellation on prognosis. DESIGN:Case-control study. (Canadian Task Force classification II-2). SETTING:Hospital Quiron-Dexeus, an academic hospital. PATIENTS:Patients with uterine sarcoma histologically diagnosed and treat...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.05.024
更新日期:2015-09-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the operative outcomes of patients undergoing either single-port or multiport laparoscopic hysterectomy (LH). METHODS:Two hundred fifty-six women scheduled for LH for symptomatic myoma and/or adenomyosis from 8 tertiary teaching hospitals were randomized to single-port or multiport groups. P...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jmig.2015.02.022
更新日期:2015-07-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the effect of endometrial ablation on 6 premenstrual symptoms for up to 1 year after treatment. DESIGN:Prospective cohort of 59 women awaiting endometrial ablation (Canadian Task Force classification II-2). SETTING:University tertiary care hospital. PATIENTS:Adult women of childbearing ag...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.01.023
更新日期:2015-05-01 00:00:00
abstract:STUDY OBJECTIVE:To report the combined hysteroscopic and laparoscopic treatment of a complete septate uterus with unilateral cervical aplasia (class U2bC3V0/ESHRE/ESGE classification) and isolated mullerian remnants. DESIGN:Step-by-step presentation of the surgical treatment (Canadian Task Force classification 4). SE...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.09.006
更新日期:2016-01-01 00:00:00
abstract::Postmenopausal women with adnexal masses suspicious for malignancy must undergo surgery for histopathologic confirmation. The low positive predictive value for malignancy of the currently available preoperative examinations results in 5 to 220 surgeries performed for each case of pelvic malignancy detected, depending ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2012.05.007
更新日期:2012-09-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2021.01.010
更新日期:2021-01-18 00:00:00
abstract::Abnormal uterine bleeding and other gynecologic complications associated with a previous cesarean section scar are only recently being identified and described. Herein we report a rare case of a woman with recurring massive uterine bleeding after 2 cesarean sections. Curettage and hormone therapy were unsuccessfully u...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2014.10.005
更新日期:2015-02-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2009.12.013
更新日期:2010-03-01 00:00:00
abstract:STUDY OBJECTIVE:To demonstrate techniques of ureterolysis during complex laparoscopic hysterectomy. DESIGN:Technical video demonstrating different approaches to ureterolysis for complex benign pathology during laparoscopic hysterectomy (Canadian Task Force classification III). SETTING:Benign gynecology department at ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2018.05.023
更新日期:2019-01-01 00:00:00
abstract:STUDY OBJECTIVE:To develop a new hysteroscopic morphologic scoring system that helps physicians, especially those who have less experience, to make a differential diagnosis among normal endometrium (NE), endometrial hyperplasia, and endometrial carcinoma. DESIGN:A retrospective study (Canadian Task Force Classificatio...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2016.02.017
更新日期:2016-07-01 00:00:00
abstract::A MEDLINE search was conducted using the keywords "laparoscopy ovarian cancer," "laparoscopy and borderline ovarian tumors," "advanced stage ovarian cancer," "laparoscopic cytoreduction ovarian cancer," "laparoscopy intraperitoneal catheter," "port-site metastases," and "carbon dioxide pneumoperitoneum." The publicati...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2009.01.007
更新日期:2009-05-01 00:00:00
abstract:STUDY OBJECTIVE:To assess features of power morcellators (blade diameter, circular vs oscillating cutting, blade rotation speed, experience level) regarding their effect on the amount of tissue spill. In addition, the amount of tissue spill after the initial two-thirds and final one-third of the morcellated specimen wa...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.09.014
更新日期:2016-01-01 00:00:00
abstract::A 69-year-old woman had a 4-year history of recurrent giant condylomas (Buschke-Lowenstein tumor) in the anal and perianal regions, with extension to the vulva and vagina. After failure of 3 surgical excisions, one of which was radical, the condition was successfully treated using carbon dioxide laser vaporization and...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2010.05.007
更新日期:2010-09-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2018.04.018
更新日期:2019-02-01 00:00:00
abstract:STUDY OBJECTIVE:To estimate the concentration of natural killer (NK) cells in the peripheral blood in patients with and without endometriosis. DESIGN:Case-control study (Canadian Task Force classification II-2). SETTING:Tertiary referral hospital. PATIENTS:One hundred fifty-five patients who had undergone videolapar...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2011.12.021
更新日期:2012-05-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
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doi:10.1016/j.jmig.2018.01.016
更新日期:2018-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
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更新日期:2007-07-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2008.06.011
更新日期:2008-09-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2008.09.619
更新日期:2009-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2019.11.003
更新日期:2020-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
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更新日期:2020-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2017.08.657
更新日期:2018-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2017.04.005
更新日期:2017-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
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更新日期:2015-07-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2019.08.014
更新日期:2020-01-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2012.10.007
更新日期:2013-03-01 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2020.05.029
更新日期:2020-06-09 00:00:00
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journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2019.07.013
更新日期:2020-01-01 00:00:00