Successful management of three cases of interstitial pregnancies with local instillation of potassium chloride: avoiding a potential cornuostomy

2021 ◽  
Vol 14 (3) ◽  
pp. e239918
Author(s):  
Vineetha Shetty ◽  
Roopa Padavagodu Shivananda ◽  
Akhila Vasudeva ◽  
Jyothi Shetty
Keyword(s):  
Potassium Chloride ◽  
Stable Condition ◽  
Uterine Cavity ◽  
Successful Outcome ◽  
Transvaginal Sonography ◽  
Technical Expertise ◽  
Successful Management ◽  
Interstitial Pregnancy ◽  
History Of ◽  
Gestational Sac

Here, we present three cases of women with interstitial pregnancy who were managed with local instillation of potassium chloride. These women were in their 20s–30s and presented in stable condition. Of them, two had a history of previous ectopic pregnancy. Interstitial pregnancy was diagnosed by transvaginal sonography which showed an empty uterine cavity with a gestational sac 1 cm away from the lateral edge of the uterine cavity, with <5 mm myometrium surrounding it in all planes. Two of the three cases failed to respond to methotrexate injection. Due to the presence of high-end ultrasound machine and technical expertise, local instillation of potassium chloride was offered as an alternative to surgical treatment, which is definitive, and all three patients had a successful outcome. One patient returned with pain in the abdomen, which required inpatient monitoring and was later diagnosed with urinary tract infection and was given appropriate antibiotics.

scholarly journals Total Laparoscopic Conservative Surgery for an Intramural Ectopic Pregnancy

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Hiroshi Nabeshima ◽  
Mitsuo Nishimoto ◽  
Hiroki Utsunomiya ◽  
Maiko Arai ◽  
Tomohisa Ugajin ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Conservative Surgery ◽  
Cystic Mass ◽  
Heart Beat ◽  
Transvaginal Sonography ◽  
Chorionic Villi ◽  
Pathologic Evaluation ◽  
History Of ◽  
Gestational Sac ◽  
Laparoscopic Removal

A 38-year-old woman, gravida 3, para 1 with a history of a left salpingectomy for an ectopic pregnancy was admitted for treatment of a presumed ectopic pregnancy. Transvaginal sonography revealed an ill-defined gestational sac and fetal heart beat within the fundal myometrium adjacent to the left cornua. Laparoscopy was performed for a suspected left cornual pregnancy or intramural pregnancy. A cystic mass 3 cm in diameter was visible within the fundal myometrium. Total laparoscopic removal of the gestational sac was performed, and the uterus was preserved. Pathologic evaluation of the excised mass demonstrated chorionic villi involving the myometrium. In the literature, only one other case describing the laparoscopic removal of an intramural pregnancy has been reported. However, in the prior report, the patient still required hysterectomy after conservative surgery. Therefore, this is the first report of the successful treatment of an intramural pregnancy exclusively with laparoscopy.

scholarly journals Ceasarean scar pregnancies, diagnosis and management

2018 ◽  
Vol 7 (4) ◽  
pp. 1592
Author(s):  
Atmajit Singh Dhillon ◽  
Sandeep Sood
Keyword(s):  
Cesarean Section ◽  
Care Service ◽  
Tertiary Care ◽  
Expectant Management ◽  
Transvaginal Sonography ◽  
Colour Doppler ◽  
History Of ◽  
Gestational Sac ◽  
Uterine Scar ◽  
High Index Of Suspicion

Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy.Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound.Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta.Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP.

scholarly journals Cornual pregnancy-an unusual site of pregnancy: a case report and literature review

2019 ◽  
Vol 10 (1) ◽  
pp. 64-67
Author(s):  
Tanzeem S Chowdhury ◽  
Homaira Hasan ◽  
TA Chowdhury
Keyword(s):  
Ectopic Pregnancy ◽  
Uterine Cavity ◽  
Uterine Wall ◽  
Unusual Presentation ◽  
Cornual Pregnancy ◽  
Diagnostic Challenge ◽  
Unusual Site ◽  
Rare Type ◽  
Interstitial Pregnancy ◽  
Gestational Sac

Ectopic pregnancy is a condition where gestational sac is located outside the uterine cavity. Cornual pregnancy, also known as interstitial pregnancy, is a rare type of ectopic pregnancy that develops in the interstitial portion of the fallopian tube and invades through the uterine wall. It poses great diagnostic challenge because of its unusual presentation and late diagnosis. Cornual pregnancy, if not diagnosed early, may present with massive and uncontrollable bleeding even leading to maternal death. We hereby report an unusual presentation of cornual pregnancy which was diagnosed and subsequently managed successfully. Birdem Med J 2020; 10(1): 64-67

scholarly journals Safety And Efficacy Of Vaginal Misoprostol In Treatment Of First Trimester Miscarriage

2020 ◽  
Vol 7 (3) ◽  
pp. 138-144
Author(s):  
Mohamed S. A. Emarah
Keyword(s):  
Medical Treatment ◽  
Initial Dose ◽  
Uterine Cavity ◽  
Medical Abortion ◽  
First Trimester ◽  
Successful Outcome ◽  
Controlled Study ◽  
Gestational Sac ◽  
Vaginal Misoprostol ◽  
Median Interval

Objective: This study was conducted to determine the outcome of medical treatment with vaginal misoprostol in missed miscarriage.          Methods: A randomized controlled study was performed in Benha Teaching Hospital between April 2016 and June 2017. Eighty patients diagnosed with miscarriage before 13 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 400 microgram (mcg) of misoprostol  vaginal as an initial dose, and repeated the same dose 4-6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). Ultrasonography at least 24 hours later from the initial dose to assess the uterine cavity if gestational products were not expelled, surgical evacuation was performed. Results:  About two-thirds of patients (77.5%) had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. Conclusion: Medical treatment with vaginal misoprostol should be a proper option for the first trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the first trimester miscarriage.

scholarly journals Angular Pregnancy Presenting as Cornual Ectopic Pregnancy

2014 ◽  
Vol 26 (1) ◽  
pp. 63-65
Author(s):  
Sankar Prosad Biswas ◽  
Suravi Halder ◽  
Feroja Banu Shirin
Keyword(s):  
Ectopic Pregnancy ◽  
Invasive Surgery ◽  
Uterine Cavity ◽  
Round Ligament ◽  
Obstetric Complication ◽  
Interstitial Pregnancy ◽  
Future Fertility ◽  
Life Threatening ◽  
Gestational Sac ◽  
Medicine Today

Angular pregnancy is a rare obstetric complication that can be life threatening. In this situation, gestational sac is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament. Angular pregnancy is distinguished from interstitial pregnancy by anatomically, where embryo is implanted lateral to round ligament. The report presented here describes a case of angular pregnancy that was suspected by ultrasound and confirmed during surgery. Laparoscopy can be useful for guiding dilatation & curettage in angular pregnancy and may circumvent the need for invasive surgery or hysterectomy. It has an impact on future fertility. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21318 Medicine Today 2014 Vol.26(1): 63-65

scholarly journals Scar Pregnancy a Diagnostic Conundrum: A Case Report

2021 ◽  
Vol 59 (235) ◽  
Author(s):  
Manoj Pokhrel ◽  
Shreedhar Prasad Acharya ◽  
Jyotshna Sharma ◽  
Meena Thapa
Keyword(s):  
Past History ◽  
Transvaginal Sonography ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Uterine Incision ◽  
History Of ◽  
Gestational Sac ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis ◽  
Previous Cesarean

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific  pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.

Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

2019 ◽  
Vol 15 (9) ◽  
pp. 906-910
Author(s):  
Hongzhang Zhu ◽  
Shi-Ting Feng ◽  
Xingqi Zhang ◽  
Zunfu Ke ◽  
Ruixi Zeng ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Stable Condition ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Cutis Verticis Gyrata ◽  
Essential Form ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

scholarly journals Rare heterotopic pregnancy after frozen embryo transfer: a case report and literature review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xianping Wang ◽  
Ding Ma ◽  
Yangang Zhang ◽  
Yanhua Chen ◽  
Yuxia Zhang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Left Kidney ◽  
Frozen Embryo Transfer ◽  
Heterotopic Pregnancy ◽  
Psoas Major Muscle ◽  
History Of ◽  
Gestational Sac ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Psoas Major

Abstract Background Heterotopic pregnancy occurred after frozen embryo transfer with two D3 embryos, and the case had a history of bilateral salpingectomy due to salpingocyesis. An ectopic heterotopic pregnancy was implanted in the left psoas major muscle, which has not been previously reported. Case presentation A 33-year-old woman presented with left back pain after curettage due to foetal arrest in the uterus without vaginal bleeding and spotting, and painkillers relieved the pain initially. When the painkillers ceased to work, the patient returned to the hospital. The β-human chorionic gonadotropin (β-hCG) level remained increased compared with the time of curettage, and a diagnosis of retroperitoneal abdominal pregnancy was suggested by ultrasonography and computerized tomography (CT) with the gestational sac implanted in the left psoas major muscle at the left hilum level. Laparotomy was performed to remove the ectopic pregnancy. During the operation, we carefully separated the adipose tissue between the space of the left kidney door and left psoas major muscle, peeled away the gestational sac that was approximately 50 mm × 40 mm with a 25-mm-long foetal bud, and gave a local injection of 10 mg of methotrexate in the psoas major muscle. Fifty days later, β-hCG decreased to normal levels. Conclusion It is necessary to pay more attention to the main complaints to exclude rare types of ectopic pregnancies of the pelvis and abdomen after embryo transfer.

3-Methylcyclohex-2-en-1-one and the Douglas-fir beetle (Coleoptera: Curculionidae): history of successful bark beetle pheromone treatments

2020 ◽  
Vol 153 (1) ◽  
pp. 62-78
Author(s):  
Darrell W. Ross
Keyword(s):  
Bark Beetle ◽  
Douglas Fir ◽  
Future Research ◽  
Beetle Species ◽  
Successful Management ◽  
Dendroctonus Pseudotsugae ◽  
Successful Development ◽  
History Of ◽  
Antiaggregation Pheromone

AbstractThis paper reviews the literature on the identification of 3-methylcyclohex-2-en-1-one (MCH) as the antiaggregation pheromone of the Douglas-fir beetle (Dendroctonus pseudotsugae Hopkins) (Coleoptera: Curculionidae) and the development of successful management applications using the pheromone. Previously unpublished data from two studies on novel uses of MCH are included. The successful development of antiaggregation pheromone-based treatments for the Douglas-fir beetle is discussed in relation to efforts to develop similar treatments for other bark beetle species, and opportunities for future research on MCH and the Douglas-fir beetle are suggested.

Rare cause of chronic abdominal pain: left paraduodenal hernia and its surgical management

2021 ◽  
Vol 14 (12) ◽  
pp. e245024
Author(s):  
Ajay Chikara ◽  
Sasidhar Reddy Karnati ◽  
Kailash Chand Kurdia ◽  
Yashwant Sakaray
Keyword(s):  
Abdominal Pain ◽  
Stable Condition ◽  
Paraduodenal Hernia ◽  
Inferior Mesenteric Vein ◽  
Anterior Border ◽  
Initial Reduction ◽  
Contrast Enhanced ◽  
History Of ◽  
Enhanced Computed Tomography

A 30-year-old man presented with colicky abdominal pain for 2 months, associated with occasional episodes of bilious vomiting. He had a history of similar complaints at the age of 16 and 26 years. Contrast-enhanced computed tomography abdomen was consistent with a diagnosis of left paraduodenal hernia. On laparoscopy a 3 × 3 cm hernial defect was identified in the left paraduodenal fossa (fossa of Landzert). Contents were jejunal, and proximal ileal loops which were dilated and edematous. Anterior border of the sac was formed by the inferior mesenteric vein and left branch of the left colic artery. Initial reduction of contents was easy. However, complete reduction proved to be difficult due to adhesions with the sac opening, the hernial sac instead laid open by dividing the Inferior Mesentric Vein (IMV) (anterior border of defect) using a vascular stapler. The patient was discharged on postoperative day 3 in a stable condition. On follow-up the patient is doing well.

Sign in / Sign up

Export Citation Format

Share Document