Page 40 - World Journal of Laparoscopic Surgery

CASE REPORT
Secondary Live Abdominal Ectopic Pregnancy: A Case Report

1
Priyakshi Chaudhry , Arpita Jaiswal 2

AbstrAct
A 27-year-old primigravida, married for 3 months, was admitted in the All India Institute of Medical Sciences (AIIMS), Delhi, with the diagnosis
of live abdominal ectopic pregnancy. She had a history of scanty menstrual flow since 2 months and brownish discharge since 15 days. The
patient had a history of normal menses priorly. Urine pregnancy test done was positive. The gestational age of the present pregnancy was 12
weeks. The patient had no complaints of pain in her abdomen, nausea, and vomiting, was doing her daily activity, which included gym and yoga.
Per abdomen examination revealed a soft nondistended abdomen. Per vaginam examination showed bulky, anteverted uterus with fullness
in right fornix and tenderness in right fornix. Investigations revealed Hb-10.6 g%, ultrasound, and CT scan showed right-sided live abdominal
ectopic pregnancy, and the vessels involved were a right uterine artery and a branch from the lower level of T11 vertebral level, fetal pole ≈12
weeks in Pouch of Douglas (POD). With this case report we highlighted the medical emergency that diagnosed should be managed promptly.
Proper preoperative evaluation, use of systemic methotrexate, availability of multidisciplinary surgical team, and proper operative technique
like minimal invasive surgery which is invaluable in modern era when incidence of ectopic pregnancy is increasing due to parallel increase in
etiological factor-like sexually transmitted diseases and assisted reproductive techniques by early detection with transvaginal ultrasound and
CT scan which can reduce maternal mortality and morbidity, offer the couple a more optimistic outlook for subsequent reproductive potential
and reduce mental, emotional trauma to the patient.
Keywords: Abdominal ectopic, High-risk obstetrics, Laparoscopy.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1372

IntroductIon 1 Department of Obstetrics and Gynaecology, Palika Maternity Hospital,

Abdominal pregnancy is defined as pregnancy anywhere within New Delhi, India
the peritoneal cavity, exclusive of tubal, ovarian, or broad ligament 2 Jawaharlal Nehru Medical College, Sawangi, Maharashtra, India
1
locations. The POD is the most common location of abdominal Corresponding Author: Priyakshi Chaudhry, Department of Obstetrics
pregnancy, followed by the mesosalpinx and omentum. However, and Gynaecology, Palika Maternity Hospital, New Delhi, India, Phone:
implantation on other abdominal organs such as the spleen, liver, +91 9975459078, e-mail: priyakshichaudhry@gmail.com
and appendix has also been reported. 2–4 The maternal mortality How to cite this article: Chaudhry P, Jaiswal A. Secondary Live
rate can be as high as 20%. Abdominal pregnancy is thought Abdominal Ectopic Pregnancy: A Case Report. World J Lap Surg
to represent around 1–1.5% of all ectopic pregnancies, with an 2019;12(2):86–87.
estimated incidence of 1:8,000 to 10,000 pregnancies. Source of support:

Abdominal pregnancies are either primary or secondary, Conflict of interest:
secondary being the more common type. Secondary abdominal
pregnancy almost always follows the early rupture of a tubal ectopic
pregnancy into the peritoneal cavity, with the incidence being from the lower level of T11 vertebral level, fetal pole ≈12 weeks in
5
1 in 10,000 live births. It usually occurs following an extra uterine POD. Patient was taken to OT under general anesthesia, transvaginal
tubal or ovarian pregnancy that ruptures and gets reimplanted ultrasound probe was introduced, and a needle was pushed into the
within the abdomen. heart of the fetus, and 2.3 mL KCl was introduced and observed for

cAse descrIptIon 1 minute, and no fetal cardiac activity was noticed post-procedure.
On day 1, β hCG levels were 93,000; according to the formula 85 mg
A 27-year-old primigravida, married for 3 months, was admitted in inj methotrexate was given IV. On day 2, β hCG levels were 93,610,
All India Medical Institute, Delhi, with the diagnosis of live abdominal on day 3—89,679, and on day 5, levels were—1,36,993, and inj
ectopic pregnancy. She had a history of scanty menstrual flow since methotrexate was repeated again. Day prior to the procedure,
2 months and brownish discharge since 15 days. The patient had under general anesthesia, 6 F arterial catheter was placed in right
a history of normal menses prior. Urine pregnancy test done was femoral artery and selective catheterization of right iliac artery and
positive. The gestational age of the present pregnancy was 12 right uterine artery was done on selective run 500 μm PVA was
weeks. The patient had no complaints of pain in her abdomen, used to embolize the gestational sac and its abnormal vascularity
nausea, and vomiting was doing her daily activity, which included subsequently abnormal vascular, branch from lower level of T11
gym and yoga. On examination, per abdomen examination revealed vertebral level was seen and was also embolized. Laparoscopic
a soft nondistended abdomen. Per vaginam examination showed removal was planned. There were adhesions between the abdomen
bulky, anteverted uterus with fullness in right fornix and tenderness and anterior abdominal wall and evidence of secondary right
in the right fornix. Investigations revealed Hb-10.6 g%, ultrasound, abdominal ectopic pregnancy at the fimbrial end measuring
and CT scan showed right-sided live abdominal ectopic pregnancy, 6 × 6 cm gestational sac. Right-sided salpingectomy was done
and the vessels involved were a right uterine artery and a branch fimbrial end along with gestational sac was excised, which was

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