MOJ
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Clinical Images Volume 8 Issue 2
Laparoscopic approach of cornual ectopic pregnancy after salpingectomy case report
R Illia,1
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Guallan F,2 Castaño Re,3 Habich D,4 Ramilo Tp,5 Valencia Jaramillo V,6 Ratto Mc6
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1Chief of Obstetrics Service, Department of Obstetrics and Gynecology, Hospital Alemán, Argentina
2Chief Resident, Department of Obstetrics and Gynecology, Hospital Alemán, Argentina
3Chief, Department of Obstetrics and Gynecology, Hospital Alemán, Argentina
4Chief of Gynecology Service, Department of Obstetrics and Gynecology, Hospital Alemán, Argentina
5Gynecological staff member, Gynecology Service, Department of Obstetrics and Gynecology, Hospital Alemán, Argentina
6Resident, Department of Obstetrics and Gynecology, Hospital Alemán, Argentina
Correspondence: Ricardo Illia, Chief of Obstetrics Service, Department of Obstetrics & Gynecology, Alemán Hospital, La Pampa 2219 5A, Argentina, Tel 1161859985
Received: August 19, 2018 | Published: April 4, 2019
Citation: Illia R, Guallan F, Re C, et al. Laparoscopic approach of cornual ectopic pregnancy after salpingectomy case report. MOJ Womens Health.2019;8(2):196-197. DOI: 10.15406/mojwh.2019.08.00235
Keywords
ectopic, pregnancy, potential risks, laparotomy, laparoscopic, excessive intraoperative, bleeding
Introduction
Cornual ectopic pregnancy (CEP) is a rare form of ectopic pregnancy with potential risks. Many of these cases are still converted to laparotomy nowadays, because of concerns about technical difficulties and risks of excessive intraoperative bleeding. We present an unusual case of an CEP in a patient diagnosed with infertility and pregnancy conceived by in vitro fertilization, which was managed by a laparoscopic approach.
Case report
A 40-year-old patient, nulliparous, with a history of adnexectomy in 2 occasions in the youth due to torsion of ovary due to benign tumor pathology on both occasions. It is performed the fifth of July of 2017 an in vitro fertilization treatment. Concurred on 30 of July of 2017 with pelvic pain and spotting. Laboratory at admission: hematocrit 41%, Hemoglobin 14 g / dl, white blood cells 8500/mm3. Beta-HCG: 3100. A vaginal ultrasound is made that informs: endometrium of 8 mm. In the left cornual area, a gestational sac containing a 2.3 mm embryo with positive cardiac activity (Figure 1).
Figure 1A gestational sac containing a 2.3 mm embryo with positive cardiac activity.
Laparoscopic approach was performed. A cornual resection was performed from the implantation base with meticulous hemostasia with monopolar electrosurgical energy (Hook). This caused minimal hemorrhage, without intraoperative complications. Subsequently, security coagulation in the surgical wound was performed with bipolar energy. The patient evolved favorably, being discharged at 12 hours after the procedures, without additional treatment requirements (Figure 2 & 3).
Figure 2The patient evolved favorably, being discharged at 12 hours after the procedures, without additional treatment requirements.
Figure 3A security coagulation in the surgical wound was performed with bipolar energy.
Discussion
CEP were traditionally treated with laparotomy and wedge resection of the uterine horn or even hysterectomy. With the advancement of minimally invasive surgery, the laparoscopic approach offers a valuable option. At present there is no consensus as to which treatment is most advisable. We can divide them into surgical or non-surgical. Among the first have been described: cornuostomy, salpingostomy, Endoloop, myometrial incision with aspiration of the trophoblast and evacuation guided by hysteroscopy. Among the medical treatments the most widespread is the into the gestational sac injection of methotrexate or sodium chloride.
Conclusion
Cornual pregnancy is a very rare location, with high maternal morbidity and mortality, so an early diagnosis should be made to avoid complications and, if possible, a minimally invasive approach if feasible.
Acknowledgements
None.
Conflict of interest
The author declares there are no conflicts of interest.
©2019 Illia, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.