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A rare cause of surgical abdomen: Heterotopic pregnancy rupture

Year 2020, Volume: 4 Issue: 4, 318 - 320, 01.04.2020
https://doi.org/10.28982/josam.702768

Abstract

Heterotopic pregnancy is simultaneous extrauterine and intrauterine localization of the fertilized ovum. In this article, we aimed to present the case of a ruptured heterotopic pregnancy patient who had abortion a week ago. A 28-year-old female patient was referred to the Emergency Department due to vaginal bleeding and abdominal pain. Physical examination revealed that the patient, who had an abortion a week ago because of unwanted pregnancy at the 7th gestational week, had widespread sensitivity in the abdomen. Active bleeding was observed in vaginal examination. Her serum β-human chorionic gonadotropin level was 14562 mIU/mL. A fetus surrounded by hematoma with an 8 mm crown-rump length and heartbeat was observed in the right adnexal area during pelvic ultrasonography. The patient was diagnosed with ruptured heterotopic pregnancy and underwent surgery. In female patients who are in reproductive age and who refer to Emergency Department with acute abdominal pain and vaginal bleeding, it must not be ignored that there might be extrauterine pregnancy along with intrauterine pregnancy and/or rupture. Ectopic pregnancy is a disease, which might occur in sexually active women in reproductive period and develops as a result of abnormal implantation of blastocyst. It can be localized in the ovaries, and less commonly, in the fallopian tubes. Ovarian pregnancy is characterized with the blastocyst being implanted in the ovary. It constitutes 0.15-3% of ectopic pregnancies and is observed in approximately one in every 7000 pregnancies. In our case, the blastocyst was localized in the right ovarian area, which is exceedingly rare.

References

  • 1. Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007 Mar;50:89-99. DOI: 10.1097/GRF.0b013e31802f4f79
  • 2. Shenoy VB, Buckley CJ. Natural conception resulting in a ruptured heterotopic pregnancy in a multiparous woman. Proc (Bayl Univ Med Cent). 2020 Jan;33(1):93-4. DOI: 10.1080/08998280.2019.1670324
  • 3. Barnhart KT, Franasiak JM. Tubal ectopic pregnancy: ACOG practice bulletin Clin Manage Guidelines Obstet Gynecol. 2018 Mar;131(3):e91-103. DOI: 10.1097/AOG.0000000000002560.
  • 4. Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 2006 Dec;46:521-7. DOI: 10.1111/j.1479-828X.2006.00653.x
  • 5. Selçuk S. Ruptured heterotopic pregnancy: Case report. J Surg Med. 2017;1(1):15-7. DOI: 10.28982/josam.337573
  • 6. Gomel V. Gomelin, jinekolojisi, Attar E, Ata B, eds. Ektopik Gebelik. İstanbul: Nobel Tıp Kitabevi; 2007. p:417-424.
  • 7. Nwanodi O, Khulpateea N. The preoperative diagnosis of primary ovarian pregnancy. J Natl Med Assoc. 2006 May;98:796-8.
  • 8. Kaplan BC, Dart RG, Moskos M, Kuligowska E, Chun B, Adel Hamid M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996 Jul;28:10-7. DOI: 10.1016/s0196-0644(96)70131-2.
  • 9. Baltarowich OH, Scoutt LM. Ectopic pregnancy. In: Norton ME, Scoutt LM, Feldstein VA, editors. Callen's ultrasonography in obstetrics and gynecology. 6th ed. Philadelphia (PA): Elsevier; 2016. p: 966–1000.
  • 10. Zhu Q, Li C, Zhao WH, Yuan JJ, Yan MX, Qin GJ, et al. Risk factors and clinical features of ovarian pregnancy: A case-control study. BMJ Open. 2014 Oct;4(12):e006447. DOI:10.1136/bmjopen-2014-006447.
  • 11. Svalingam NS, Duncan WC, Kirk E, Shepard LA, Home AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011 Oct;37(4):231-40. DOI: 10.1136/jfprhc-2011-0073.

Cerrahi batının nadir bir nedeni: Heterotopik gebelik rüptürü

Year 2020, Volume: 4 Issue: 4, 318 - 320, 01.04.2020
https://doi.org/10.28982/josam.702768

Abstract

Heterotopik gebelik, fertilize ovumun eş zamanlı olarak ekstrauterin ve intrauterin yerleşimidir. Yazımızda bir hafta önce kürtaj olmuş rüptüre heterotopik gebelik olgusunu literatür eşliğinde tartışmayı amaçladık. Yirmi sekiz yaşında kadın hasta vajinal kanama ve karın ağrısı şikayetleri nedeniyle acil servise müracaat etti. Bir hafta önce, 7 haftalık intrauterin istenmeyen gebelik nedeniyle kürtaj olan hastanın fizik muayenede batında yaygın hassasiyeti mevcut idi. Vajinal muayenede aktif kanama izlendi. Kan tetkik sonuçlarında serum β-human koryonik gonadotropin düzeyi 14562 mlU/mL olduğu saptandı. Yapılan ultrasonografide sağ adneksiyal alanda, kalp atımı mevcut crown-rump length 8 mm ve etrafında hematom mevcut fetüs izlendi. Hastaya rüptüre heterotopik gebelik tanısı konularak ameliyata alındı. Ektopik gebelik, üreğen dönemde cinsel yönden aktif olan kadınlarda ortaya çıkabilen çok ciddi hastalıklardan birisidir. Blastokistin anormal implantasyonu sonucu gelişen ektopik gebelik en sık fallop tüplerinde, daha az sıklıkta over yerleşimli olabilir. Ovaryan gebelik, blastokistin over içinde implante olması ile karakterizedir. Ektopik gebeliklerin %0,15-3’ünü oluşturur. Yaklaşık 7000 gebelikte bir görülmektedir. Bizim vakamızda blastokist, nadir görülen bir yerleşim yeri olan sağ over lokasyonundaydı. Akut karın ağrısı ve vaginal kanama şikayetleriyle acil servise gelen üreme dönemdeki bayan hastalarda intrauterin ile beraber ekstrauterin gebelik ve/veya rüptürü de olabileceği göz ardı edilmemelidir.

References

  • 1. Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007 Mar;50:89-99. DOI: 10.1097/GRF.0b013e31802f4f79
  • 2. Shenoy VB, Buckley CJ. Natural conception resulting in a ruptured heterotopic pregnancy in a multiparous woman. Proc (Bayl Univ Med Cent). 2020 Jan;33(1):93-4. DOI: 10.1080/08998280.2019.1670324
  • 3. Barnhart KT, Franasiak JM. Tubal ectopic pregnancy: ACOG practice bulletin Clin Manage Guidelines Obstet Gynecol. 2018 Mar;131(3):e91-103. DOI: 10.1097/AOG.0000000000002560.
  • 4. Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 2006 Dec;46:521-7. DOI: 10.1111/j.1479-828X.2006.00653.x
  • 5. Selçuk S. Ruptured heterotopic pregnancy: Case report. J Surg Med. 2017;1(1):15-7. DOI: 10.28982/josam.337573
  • 6. Gomel V. Gomelin, jinekolojisi, Attar E, Ata B, eds. Ektopik Gebelik. İstanbul: Nobel Tıp Kitabevi; 2007. p:417-424.
  • 7. Nwanodi O, Khulpateea N. The preoperative diagnosis of primary ovarian pregnancy. J Natl Med Assoc. 2006 May;98:796-8.
  • 8. Kaplan BC, Dart RG, Moskos M, Kuligowska E, Chun B, Adel Hamid M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996 Jul;28:10-7. DOI: 10.1016/s0196-0644(96)70131-2.
  • 9. Baltarowich OH, Scoutt LM. Ectopic pregnancy. In: Norton ME, Scoutt LM, Feldstein VA, editors. Callen's ultrasonography in obstetrics and gynecology. 6th ed. Philadelphia (PA): Elsevier; 2016. p: 966–1000.
  • 10. Zhu Q, Li C, Zhao WH, Yuan JJ, Yan MX, Qin GJ, et al. Risk factors and clinical features of ovarian pregnancy: A case-control study. BMJ Open. 2014 Oct;4(12):e006447. DOI:10.1136/bmjopen-2014-006447.
  • 11. Svalingam NS, Duncan WC, Kirk E, Shepard LA, Home AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011 Oct;37(4):231-40. DOI: 10.1136/jfprhc-2011-0073.
There are 11 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Case report
Authors

Mehmet Erdi Yılmaz 0000-0001-6974-812X

Cansu Kızıltaş 0000-0001-6416-941X

Selman Yeniocak 0000-0002-1124-396X

Vildan Özer This is me 0000-0002-2514-5674

Abdulkadir Gündüz 0000-0001-8591-9769

Publication Date April 1, 2020
Published in Issue Year 2020 Volume: 4 Issue: 4

Cite

APA Yılmaz, M. E., Kızıltaş, C., Yeniocak, S., Özer, V., et al. (2020). A rare cause of surgical abdomen: Heterotopic pregnancy rupture. Journal of Surgery and Medicine, 4(4), 318-320. https://doi.org/10.28982/josam.702768
AMA Yılmaz ME, Kızıltaş C, Yeniocak S, Özer V, Gündüz A. A rare cause of surgical abdomen: Heterotopic pregnancy rupture. J Surg Med. April 2020;4(4):318-320. doi:10.28982/josam.702768
Chicago Yılmaz, Mehmet Erdi, Cansu Kızıltaş, Selman Yeniocak, Vildan Özer, and Abdulkadir Gündüz. “A Rare Cause of Surgical Abdomen: Heterotopic Pregnancy Rupture”. Journal of Surgery and Medicine 4, no. 4 (April 2020): 318-20. https://doi.org/10.28982/josam.702768.
EndNote Yılmaz ME, Kızıltaş C, Yeniocak S, Özer V, Gündüz A (April 1, 2020) A rare cause of surgical abdomen: Heterotopic pregnancy rupture. Journal of Surgery and Medicine 4 4 318–320.
IEEE M. E. Yılmaz, C. Kızıltaş, S. Yeniocak, V. Özer, and A. Gündüz, “A rare cause of surgical abdomen: Heterotopic pregnancy rupture”, J Surg Med, vol. 4, no. 4, pp. 318–320, 2020, doi: 10.28982/josam.702768.
ISNAD Yılmaz, Mehmet Erdi et al. “A Rare Cause of Surgical Abdomen: Heterotopic Pregnancy Rupture”. Journal of Surgery and Medicine 4/4 (April 2020), 318-320. https://doi.org/10.28982/josam.702768.
JAMA Yılmaz ME, Kızıltaş C, Yeniocak S, Özer V, Gündüz A. A rare cause of surgical abdomen: Heterotopic pregnancy rupture. J Surg Med. 2020;4:318–320.
MLA Yılmaz, Mehmet Erdi et al. “A Rare Cause of Surgical Abdomen: Heterotopic Pregnancy Rupture”. Journal of Surgery and Medicine, vol. 4, no. 4, 2020, pp. 318-20, doi:10.28982/josam.702768.
Vancouver Yılmaz ME, Kızıltaş C, Yeniocak S, Özer V, Gündüz A. A rare cause of surgical abdomen: Heterotopic pregnancy rupture. J Surg Med. 2020;4(4):318-20.