| The first case is presented of coexistance of an ectopic pregnancy and an adenomatoid tumor in the same fallopian tube. The ectopic pregnancy was diagnosed clinically, but the tumor was only detected microscopically as a result of extensive sampling of the salpingectomy specimen. ( info) |
2/337. Heterotopic pregnancy: discovery of ectopic pregnancy after elective abortion. We report a case of combined intrauterine and tubal pregnancy in a 23-year-old woman. The patient came to the emergency department complaining of lower abdominal pain after having had an elective abortion 2 weeks earlier. Her physician had done pelvic ultrasonography, noting an intrauterine pregnancy before the abortion. Our working diagnosis in the emergency department was retained products of conception versus postabortion endometritis. Pelvic ultrasonography in the emergency department revealed an ectopic pregnancy without evidence of retained products of conception, and the patient had a right salpingotomy with removal of the ectopic fetus without complications. ( info) |
| OBJECTIVE: To investigate the usefulness of ultrasonography (USG) and magnetic resonance imaging (MRI) in the early diagnosis of interstitial pregnancy. STUDY DESIGN: Four cases of interstitial pregnancy that showed characteristic ultrasonographic and MRI findings were studied. All cases received cornual resection, and the presence of interstitial pregnancy was confirmed by pathologic examination. RESULTS: Three of four cases had a gestational sac in the uterine cornu or a protruding cornual mass and myometrium between the sac and uterine cavity on both USG and MRI. In the remaining case, preoperative diagnosis was inconclusive because no gestational sac was demonstrated by USG or MRI. color flow mapping was conducted in three cases and revealed prominent peritrophoblastic blood flow. CONCLUSION: The findings suggest that USG combined with color flow mapping is the first choice in the early diagnosis of interstitial pregnancy. MRI, which is an extremely expensive imaging technology, should be used only if transvaginal USG with color flow mapping is inconclusive in ruling out the diagnosis of interstitial pregnancy. ( info) |
| The presentation of acute abdominal pain in young women is not an unusual occurrence in casualty and gynaecology departments. Both acute appendicitis and ectopic pregnancy have to be considered and investigated, as these two conditions are accepted as the most common surgical causes of an acute abdomen. Difficulties in correctly identifying the cause of the pain can be hazardous to the patient and care needs to be taken in obtaining a prompt and accurate diagnosis enabling the most appropriate management. The case report presented here describes the extremely unusual occurrence of both these acute conditions happening simultaneously with the added complication of an ongoing twin pregnancy and it highlights the need to look beyond the most obvious diagnosis and always to expect the unexpected. ( info) |
5/337. A new laparoscopic approach for the treatment of interstitial ectopic pregnancy. Laparoscopic surgery is currently the preferred treatment for ectopic pregnancy. Interstitial tubal pregnancy is a rare and dangerous form of ectopic pregnancy that is usually treated by cornual resection or hysterectomy. In this patient, it was treated laparoscopically with a simple and safe method using three endoloops. The procedure is swift with minimal blood loss, and can be performed by any gynecologist who has experience with endoscopic surgery. (J Am Assoc Gynecol Laparosc 6(2):205-207, 1999) ( info) |
6/337. Heterotopic pregnancy with term delivery after rupture of a first-trimester tubal pregnancy. A case report. BACKGROUND: Because heterotopic pregnancy is rare, the presence of an intrauterine pregnancy tends to impede early diagnosis and definitive intervention for the ectopic component. Delay in diagnosing the condition and failure to proceed quickly with the requisite anesthesia and surgery can jeopardize both maternal well-being and survival of the intrauterine fetus. CASE: A patient with heterotopic pregnancy carried the intrauterine pregnancy to term following first-trimester rupture of the tubal pregnancy, with hypovolemic shock. CONCLUSION: Prompt diagnosis, rapid fluid and blood resuscitation, heart-sparing anesthesia and gentle, expeditious surgery collectively contributed to the favorable outcome for the mother and surviving infant. ( info) |
7/337. Hydrosalpinx due to asymptomatic bilateral tubal pregnancies associated with metaplastic papillary tumor of the fallopian tube. The patient described in this report had bilateral hydrosalpinx due to pregnancies in both fallopian tubes, treated by laparoscopic resection. Histologically, both fallopian tubes revealed intratubal occlusion by degenerated, partially calcified chorionic tissue. An incidental finding was an intraluminal papillary epithelial tumor in one of the fallopian tubes. The clinical significance and complications of asymptomatic tubal ectopic pregnancy and the pathogenesis and biologic behavior of papillary epithelial tumors of the fallopian tube are briefly discussed. ( info) |
8/337. Tubal pregnancy in a unicornuate uterus with rudimentary horn: a case report. OBJECTIVE: To report a case of tubal pregnancy in a unicornuate uterus with rudimentary horn on the side of the rudiment and its pathology. DESIGN: Case report. SETTING: University hospital. PATIENT: An 18-year-old woman, primigravida, with tubal pregnancy. INTERVENTION(S): Systemic administration of methotrexate, salpingectomy by laparotomy, and laparoscopic surgery for resection of rudimentary horn. MAIN OUTCOME MEASURE(S): Emergent laparotomy revealed that the intraperitoneal hemorrhage was caused by the rupture of the tubal pregnancy on the same side as the rudimentary horn of the unicornuate uterus. A corpus luteum was found at the ipsilateral ovary of the rudimentary horn. RESULT(S): Image diagnosis and pathological examination of the rudimentary horn revealed that this uterine malformation was a unicornuate uterus with a noncommunicated, noncavitary rudimentary horn, corresponding to class IIc of the American fertility Society classification of mullerian anomalies. CONCLUSION(S): This is the first report of a tubal pregnancy on the side of the noncommunicating rudimentary horn with the ipsilateral ovary carrying a corpus luteum in a unicornuate uterus. ( info) |
9/337. Ectopic pregnancy after transmyometrial embryo transfer: case report. OBJECTIVE: To report a case of ectopic pregnancy after transvaginal transmyometrial ET. DESIGN: Case report. SETTING: University-based IVF program. PATIENT(S): A woman with tubal subfertility and a history of difficult ETs. INTERVENTION(S): Transvaginal transmyometrial ET performed to avoid a difficult transcervical ET. MAIN OUTCOME MEASURE(S): Expected improvement in the pregnancy rate in a selected group of patients. RESULT(S): Tubal pregnancy. CONCLUSION(S): Transmyometrial ET is an attractive alternative to difficult transcervical ET but is not free of complications. ( info) |
10/337. Heterotopic pregnancy in a spontaneous cycle: do not forget about it! Heterotopic pregnancies are estimated to be less frequent than 1:30000 if no assisted reproduction technologies (ART) are performed. After ART this entity is more frequent and in the range of 1:100. In the case reported here an ectopic pregnancy was detected in the right fallopian tube at 7 1 weeks of gestation. It was misdiagnosed as an ectopic singleton, and treated by laparoscopic salpingectomy, because of a previous ectopic in the same tube. Rising hCG after laparoscopy during the subsequent days followed by ultrasound evaluation revealed a viable intrauterine pregnancy. The pregnancy continued uneventfully and a healthy child was delivered at term. The problems, which lead to the misdiagnosis are discussed. The problem of rare cases in medicine, and the problems of a 'modern' medicine are discussed. ( info) |