Журнал клинических случаев

Peritoneal Pregnancy Missed at Initial Laparoscopy

Abstract

Christopher M Tarney and Steve Hong

Ectopic pregnancy accounts for 2% of all first-trimester pregnancies and within the United States it remains as the leading cause for maternal death in the first trimester. Early detection of an ectopic pregnancy is imperative to ensure prompt treatment, which includes possible medical or surgical management to prevent life-threatening complications. Most ectopic pregnancies implant within the fallopian tube, but ectopic pregnancies can occur in the cervix, abdomen, ovary, or uterine cornua. These types of ectopic pregnancies are often harder to detect and have an increased risk for hemorrhage. We present a case of a peritoneal pregnancy which was missed at initial laparoscopy in which operative findings were notable for a bleeding right fallopian tube with no evidence of the gestational tissue. An exploratory laparotomy was performed twenty-four hours later for concerns of an acute abdomen revealed an ectopic implant with active bleeding and peritoneal erosion over the rectum. This case illustrates the ramifications of a ruptured ectopic pregnancy and also highlights the limitations of laparoscopy as a diagnostic modality in evaluating for an ectopic pregnancy