Images in Endoscopy
Ruptured Ectopic (Cornual) Pregnancy Sebastiaan Veersema, MD*, and Anne Damoiseaux, MD From the St. Antonius Hospital, Nieuwegein, The Netherlands (Dr. Veersema), and University Medical Center Utrecht, Utrecht, The Netherlands (Dr. Damoiseaux).
Case Report A 38-year-old woman visited the emergency department with abdominal pain of 2-hour duration. She was anxious and pale with cold clammy skin; blood pressure was 80/40 mm hg, with a tachycardia of 100. A urinary pregnancy test produced positive findings and vaginal ultrasound showed hemoperitoneum without signs of an intrauterine pregnancy. A rupture of an ectopic pregnancy was suggested and the patient was prepared for surgical intervention. Emergency laparoscopy was performed, which showed a large amount of intraabdominal clots [1]. After evacuation of ap-
Fig. 2. Laparoscopic view of ectopic (cornual) ruptured pregnancy with placental tissue.
Fig. 1. Intraabdominal fetus. The authors have no commercial, proprietary, or financial interest in the products or companies described in this article. Corresponding author: Sebastiaan Veersema, St. Antonius Hospital, Post Box 2500, 3430 EM Nieuwegein, The Netherlands. E-mail:
[email protected] Submitted November 11, 2008. Accepted for publication November 14, 2008. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2009 AAGL. All rights reserved. doi:10.1016/j.jmig.2008.11.015
proximately 2.5 L of hemoperitoneum, a rupture of a right corneal (interstitial) pregnancy with an intraabdominal fetus of approximately 15 weeks was recognized. Laparotomy and excision of the ectopic pregnancy and salpingectomy on both sides were performed with suturing of the uterine defect. The fetus was free in the abdominal cavity (Fig. 1). Fig. 2 shows the placental site within the corneal area. On both sides there was salpingitis isthmica nodosa. The postoperative course was uneventful. Histologic examination revealed severe salpingitis isthmica nodosa and a fetus and placenta of 15 weeks’ pregnancy. The patient was well at discharge and at the 6-week follow-up.
Reference 1. Sagiv R, Debby A, Sadan O, Malinger G, Glezerman M, Golan A. Laparoscopic surgery for extrauterine pregnancy in hemodynamically unstable patients. J Am Assoc Gynecol Laparosc. 2001;4:529–532.
