Korean J Obstet Gynecol.  2011 Dec;54(12):812-816. 10.5468/KJOG.2011.54.12.812.

Successful management of abdominal pregnancy implanted on posterior cul-de-sac with postoperative selective transcatheter artery embolization: A case report

• Kim YR
• Jeon GS
• Jeong YJ
• Lee JH
• Cho DH

• KMID: 1443948
• DOI: http://doi.org/10.5468/KJOG.2011.54.12.812

Abstract

Primary abdominal pregnancy with implantation on the posterior cul-de-sac area is a very rare form of ectopic pregnancy that involves nonspecific clinical symptoms and physical findings, making early diagnosis very difficult. Whereas diagnostic laparoscopy can be performed in suspicious of abdominal pregnancy for accurate diagnosis and treatment, complete ligation of the vessel supplying blood to the placenta during surgery is often difficult. In many cases, there is continuous massive hemorrhage after litigation, significantly increasing maternal morbidity and mortality. We herein report with literature references a case of a 33-year-old female patient of primary abdominal pregnancy with implantation on the posterior cul-de-sac area. She showed hemostatic failure in a blood vessel after undergoing a surgery to remove the gestational sac, and was successfully treated with additional transcatheter arterial embolization.

Keyword

Posterior cul-de-sac; Abdominal pregnancy; Transcatheter arterial embolization

MeSH Terms

Adult
Arteries
Blood Vessels
Early Diagnosis
Female
Gestational Sac
Glycosaminoglycans
Hemorrhage
Humans
Jurisprudence
Laparoscopy
Ligation
Placenta
Pregnancy
Pregnancy, Abdominal
Pregnancy, Ectopic
Glycosaminoglycans

Figure

• 

  Fig. 1 Laparoscopic operation findings (A) Hematoma and blood clots are noted in pelvic cavity. (B) Left salpinx shows normal appearance with Lt. dermoid cyst. (C) Right adnexa shows normal appearance. (D) About 3 × 4 cm sized cystic mass was noted on posterior cul-de-sac (white arrow).

• 

  Fig. 2 (A) Right inferior epigastric artery angiogram showed contrast extravasation (black arrow). (B) To protect the distal portion of inferior epigastric artery, embolization was done.

Reference

1. Atrash HK, Friede A, Hogue CJ. Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol. 1987. 69:333–337.

2. Delke I, Veridiano NP, Tancer ML. Abdominal pregnancy: review of current management and addition of 10 cases. Obstet Gynecol. 1982. 60:200–204.

3. Bayless RB. Nontubal ectopic pregnancy. Clin Obstet Gynecol. 1987. 30:191–199.

4. Studdiford WE. Primary peritoneal pregnancy. Am J Obstet Gynecol. 1942. 44:487–491.

5. Martin JN Jr, McCaul JF 4th. Emergent management of abdominal pregnancy. Clin Obstet Gynecol. 1990. 33:438–447.

6. Beacham WD, Hernquist WC, Beacham DW, Webster HD. Abdominal pregnancy at Charity Hospital in New Orleans. Am J Obstet Gynecol. 1962. 84:1257–1270.

7. Bombard AT, Nakagawa S, Runowicz CD, Cohen BL, Mikhail MS, Nitowsky HM. Early detection of abdominal pregnancy by maternal serum AFP+ screening. Prenat Diagn. 1994. 14:1155–1157.

8. Akhan O, Cekirge S, Senaati S, Besim A. Sonographic diagnosis of an abdominal ectopic pregnancy. AJR Am J Roentgenol. 1990. 155:197–198.

9. Costa SD, Presley J, Bastert G. Advanced abdominal pregnancy. Obstet Gynecol Surv. 1991. 46:515–525.

10. Kwon JY, Shin WM, Yoon JS, Hwang SJ, Park IY, Min KO, et al. A case of abdominal pregnancy implanted on uterosacral ligament. Korean J Obstet Gynecol. 2007. 50:1027–1032.

11. Seok HH, Lee WS, Yoon TK, Kim SH, Won HJ, Kim YS, et al. A case of abdominal pregnancy on abdominal scar following in vitro fertilization and embryo transfer in a patient with bilateral tubal obstruction. Korean J Obstet Gynecol. 2008. 51:355–358.

12. Oliver JA Jr, Lance JS. Selective embolization to control massive hemorrhage following pelvic surgery. Am J Obstet Gynecol. 1979. 135:431–432.

13. Heaston DK, Mineau DE, Brown BJ, Miller FJ Jr. Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation. AJR Am J Roentgenol. 1979. 133:152–154.

14. Ulflacker R, Wholey MH. Uflacker R, editor. Interventional radiology. Embolization procedure: techniques and materials. 1991. New York: McGraw-Hill;17–19.

15. Seok JM, Moon MJ, Chang SW, Lee YM, Jang JH, Baek MJ. Successful management of cesarean scar pregnancy at 13 weeks of gestation by uterine artery embolization: a case report. Korean J Obstet Gynecol. 2010. 53:934–939.