1/17. Abdominal pregnancy in a 67-year-old woman undetected for 37 years. A case report.BACKGROUND: Abdominal pregnancy is an exceedingly rare occurrence, but even more unusual is prolonged retention of an advanced abdominal pregnancy with lithopedion formation. We present the case of prolonged retention of an advanced abdominal pregnancy in an elderly women. CASE: A 67-year-old, white woman presented to the emergency department with abdominal pain. An acute abdominal series revealed a fetal skeleton extending from the patient's pelvis to her lower costal margins. Pelvic examination revealed a normal postmenopausal uterus, and human chorionic gonadotropin was negative. On further questioning the patient reported that she had become pregnant 37 years earlier and was diagnosed as having a "missed" pregnancy. She refused intervention at that time but suffered no untoward consequences. She reported having had later a healthy intrauterine pregnancy, delivered vaginally at term. No attempt was made to remove the prior missed abdominal pregnancy. The acute pain episode resolved, and there was no surgical intervention. CONCLUSION: Abdominal pregnancies can have a complex course, and management decisions can be difficult. This case presents an unusual outcome of an advanced abdominal pregnancy and illustrates a unique approach to management.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/17. Primary peritoneal pregnancy implanted on the uterosacral ligament: a case report.Peritoneal pregnancies are classified as primary and secondary. Primary implantation on the peritoneum is extremely rare in extrauterine pregnancy and is a potentially life-threatening variation of ectopic pregnancy within the peritoneal cavity, representing a grave risk to maternal health. Secondary abdominal pregnancies are by far the most common and result from tubal abortion or rupture, or less often, after uterine rupture with subsequent implantation within abdomen. early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. We report a case of primary peritoneal pregnancy in a 28-year-old woman, who had severe lower abdominal pain one day before laparotomy for a preoperative diagnosis of ectopic pregnancy. The conceptus was implanted on the left uterosacral ligament. A fresh embryo of approximately 8 weeks' gestation was found in the conceptus.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
3/17. Successful laparoscopic treatment of an abdominal pregnancy in the posterior cul-de-sac.PURPOSE: To describe the laparoscopic treatment of a first trimester abdominal pregnancy found in the cul-de-sac between the right uterosacral ligament and the rectum. CASE REPORT: A 32-year-old female presented to the emergency department with abdominal pain beginning a few hours prior to presentation. The serum betahCG level was 543 mIU/ml. An ultrasound examination revealed an empty uterus, bilateral normal fallopian tubes, and a large quantity of fluid in the pelvis. Secondary to patient symptoms, laparoscopy was performed. After the pelvis was irrigated to remove blood and clot, bilaterally normal fallopian tubes and ovaries were found. Further laparoscopic examination revealed an abdominal pregnancy implanted on the peritoneum between the right uterosacral ligament and the rectum. Hydrodissection was used to help elevate the peritoneum away from adjacent structures, and the products of conception were removed laparoscopically. CONCLUSION: In select first trimester patients with abdominal pregnancies, laparoscopic management can be performed.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
4/17. Secondary abdominal pregnancy in a Jehovah's Witness.A 35-year-old woman, gravida 2, para 1, aborta 0, arrived at our emergency department with abdominal pain of more than 2 weeks' duration. Diagnostic pelvic ultrasonography confirmed a 16-week intra-abdominal pregnancy. Hemoglobin level was 6.9 mg/dL, and hematocrit value was 20.1%. The patient refused blood transfusion on religious grounds. laparotomy revealed 2,000 mL of blood in the abdomen and a live fetus, with the placenta attached to the omentum and the serosal surface of the right fallopian tube. Postoperative hemoglobin level was 2.8 mg/dL. The patient was transferred to another facility for hyperbaric oxygen therapy, where she subsequently died. Abdominal pregnancy is rare, but has high fetal and maternal mortality rates. Our patient's case was complicated, since she was a Jehovah's Witness and refused lifesaving treatment on religious grounds. Serious medical decisions were made, while respecting the autonomy of the patient.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
5/17. Lithopedion.Lithopedion is a rare obstetrical outcome of an undiagnosed and untreated advanced abdominal pregnancy, mostly found incidentally. We present a case of lithopedion. In a 76 year-old female suffering from cervical neoplasm, total abdominal hysterectomy was performed for the lesion and the lithopedion was found incidentally. The patient's history was unremarkable, and laboratory tests were normal. The patient recalled having experienced a severe abdominal pain about 50 years before. Her physician had felt "a benign tumor" in her pelvis at that time, indicating that the stone child had retained in the maternal peritoneal cavity for 50 years.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
6/17. Laparoscopic management of early primary abdominal pregnancy.BACKGROUND: Abdominal pregnancy is a very rare condition with a high mortality rate. CASE: A 29-year-old woman with a history of primary infertility was admitted because of lower abdominal pain, bloody vaginal discharge, and positive urine pregnancy test. Transvaginal ultrasonography revealed a 27 x 25-mm mass containing a gestational sac-like structure located outside the uterus. At laparoscopy, a clot was revealed including chorionic villi, adherent to the peritoneum in the right vesicouterine pouch. This was removed along with the adherent peritoneum. Postoperative histology revealed invasion of chorionic tissues into peritoneum. CONCLUSION: early diagnosis of an ectopic pregnancy by transvaginal ultrasonography enabled the laparoscopic management of early abdominal pregnancy.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
7/17. Primary splenic pregnancy. A case report.BACKGROUND: Ectopic pregnancy in the upper abdominal organs is very rare but has been known to occur in the liver, spleen and lesser sac. Primary splenic pregnancy is considered the rarest form of extrauterine pregnancy, with only few well-documented cases reported. CASE: Intraperitoneal bleeding and shock resulted from a primary splenic pregnancy in a 37-year-old woman. CONCLUSION: Primary splenic pregnancy usually presents with upper left abdominal pain and intraperitoneal bleeding. It requires an emergency splenectomy and should be considered in the differential diagnosis of acute abdomen in reproductive-age women.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
8/17. Conservative treatment of ectopic pregnancy in a cesarean scar.BACKGROUND: pregnancy developing in a cesarean scar is a very rare but possibly life-threatening condition because of the risk of rupture and excessive hemorrhage. CASE: A 34-year-old woman presented with lower abdominal pain at 6 weeks of gestation. A cesarean delivery had been performed 3 years earlier. Transvaginal ultrasound examination revealed a viable pregnancy developing in the anterior wall of the uterus. The patient was treated successfully with systemic methotrexate and curettage. CONCLUSION: Conservative management with methotrexate and curettage can be considered in the treatment of ectopic cesarean scar pregnancy.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
9/17. Heterotopic pregnancy with spontaneous vaginal delivery at 36 weeks and laparotomy at term--a case report.Heterotopic pregnancy, although rare, is occurring more frequently because of an increase in genital infection and the escalating use of new reproductive technologies in infertility patients. The case of a 30-year-old para 2 1 prophetess is presented. She had a spontaneous vaginal delivery at term. Persistent abdominal pain and distension led to suspicion of heterotopic pregnancy. This was confirmed by ultrasonography. laparotomy revealed a macerated fetus in the peritoneal cavity The purpose of this report is to sensitise practitioners about the reality and existence of the condition.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
10/17. Advanced abdominal pregnancy: a case report.A 37-year-old, gravida 5 with 41 weeks of gestation was admitted because of slight vaginal bleeding, abdominal pain, and absence of fetal movements for a few days. Previously she had been admitted to a provincial hospital with sudden severe abdominal pain and fainting at the second month of her pregnancy and ectopic pregnancy was suspected. She was discharged the following morning, after all signs and symptoms had completely disappeared without any special investigation. On her last admission all clinical examinations were normal but fetal heart sound was absent. The cervix was closed and uneffaced. Abdominal X-ray showed signs of fetal death. Sonography confirmed a dead fetus in utero but with placenta previa totalis. A laparotomy was performed. A macerated female fetus, weighting 3,800 g was found in the amniotic sac lying in the abdominal cavity. The placenta was attached to the dorsal surface of her abdomen close to the large intestine and the omentum; the entire placenta was untouched and left in the peritoneal cavity. There were no postoperative complications. She recovered well and was discharged after 7 days.- - - - - - - - - - ranking = 2keywords = abdominal pain (Clic here for more details about this article) |
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