Interstitial Pregnancy: From Medical to Surgical Approach—Report of Three Cases

Background. Interstitial pregnancy is a rare form of ectopic pregnancy that usually leads to uterine rupture resulting in sudden life-threatening haemorrhage, need for blood transfusion, and admission to intensive care unit. Mortality rate is 6–7 times higher than that in classical ectopic pregnancy. Uterine rupture has been typically reported to occur at more advanced gestational ages compared to tubal pregnancy although several recent reports have shown a high risk of rupture before 12 weeks of gestation. Cases Presentation. We report three cases of women affected by interstitial pregnancy, with different clinical symptoms, and managed to be treated with surgery or medical therapy. An emergency laparotomy was performed in the first case by the general surgeon, while in the second case laparoscopy was made by a gynecologist; last case shows the success of systemic administration of methotrexate. Conclusion. Interstitial pregnancy is still a challenging condition to diagnose and treat; early diagnosis may help to choose the proper management.

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Disturbed Interstitial Pregnancy: A First Case of Successful Treatment Using a Mini-Laparoscopic Approach

Medicina ◽

10.3390/medicina55050215 ◽

2019 ◽

Vol 55 (5) ◽

pp. 215 ◽

Cited By ~ 2

Author(s):

Latchesar Tantchev ◽

Andrey Kotzev ◽

Angel Yordanov

Keyword(s):

Ectopic Pregnancy ◽

Fallopian Tube ◽

Laparoscopic Approach ◽

Massive Hemorrhage ◽

Interstitial Pregnancy ◽

First Case ◽

Threatening Condition ◽

Life Threatening ◽

Interstitial Ectopic Pregnancy ◽

Experienced Team

Interstitial ectopic pregnancy (EP) is a life-threatening condition due to the risk of massive hemorrhage in the event of its disturbance. We present the case of a 27-year-old patient who was admitted with massive hemoperitoneum, caused by the rupture of an interstitial pregnancy in the area of the fallopian tube stump, which had been removed after a previous ectopic pregnancy. The condition was overcome using a mini-laparoscopic approach (2.6 mm, 30° optics), with one 3 mm port for micro-laparoscopic instruments and one 10 mm port. Such an approach has not yet been reported in the available literature, among the casuistically reported cases of pregnancy in the tubal stump. We consider that the technique is safe, completely in the interest of the patient, applicable by an experienced team, and in agreement with modern trends regarding the minimization of operative access.

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Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency

BMJ Case Reports ◽

10.1136/bcr-2018-228493 ◽

2019 ◽

Vol 12 (5) ◽

pp. e228493 ◽

Cited By ~ 2

Author(s):

Bedayah Amro ◽

Ghassan Lotfi

Keyword(s):

Early Pregnancy ◽

Uterine Rupture ◽

Laparoscopic Approach ◽

First Trimester ◽

Rare Occurrence ◽

Spontaneous Uterine Rupture ◽

First Case ◽

Life Threatening ◽

First Trimester Of Pregnancy ◽

Underlying Risk

Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.

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Perforation Peritonitis at High Altitude

Journal of Nepal Medical Association ◽

10.31729/jnma.3488 ◽

2018 ◽

Vol 56 (210) ◽

pp. 625-628 ◽

Cited By ~ 1

Author(s):

Bhawana Amatya ◽

Paleswan Joshi Lakhey ◽

Prativa Pandey

Keyword(s):

High Altitude ◽

Distal Gastrectomy ◽

Acute Mountain Sickness ◽

Emergency Laparotomy ◽

Delay In Diagnosis ◽

First Case ◽

Life Threatening ◽

Perforation Peritonitis ◽

Proper Diagnosis ◽

Mountain Sickness

Trekkers going to high altitude can suffer from several ailments both during and after their treks. Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to acute mountain sickness or due to a gastro-intestinal illness. Occasionally, complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present two rare cases of duodenal and gastric perforations in trekkers who were evacuated from the Everest trekking region. Both of them had to undergo emergency laparotomy and repair of the perforation using modified Graham’s patch in the first case and distal gastrectomy that included the perforated site, followed by two-layer end-to-side gastrojejunostomy and two-layer side-to-side jejunostomy in the second case. Perforation peritonitis at high-altitude, though rare, can be life threatening. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential

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Uterine Rupture with Massive Late Postpartum Hemorrhage due to Placenta Percreta Left Partially In Situ

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/906351 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Mehmet Coskun Salman ◽

Pinar Calis ◽

Ozgur Deren

Keyword(s):

Uterine Rupture ◽

Bladder Wall ◽

Placental Tissue ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Uterine Wall ◽

Placenta Percreta ◽

Emergency Laparotomy ◽

Life Threatening

Placental adhesive disorders involve the growth of placental tissue into or through the uterine wall. Among these disorders, placenta percreta is the rarest one. However, it may cause significant complications. This report aimed to report a neglected patient with placenta percreta who developed uterine rupture with life-threatening late postpartum intra-abdominal hemorrhage. On admission, the patient had acute abdomen with moderate abdominal distention and was subjected to emergency laparotomy. A full-thickness defect of the anterior uterine wall involving the hysterotomy site was seen. Placental tissues occupied both sides of the incision and posterior bladder wall was also invaded by placenta. Total abdominal hysterectomy with partial resection of the posterior bladder wall was performed.

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Caesarean Scar Pregnancy - A Rare Case Report

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v27i2.29924 ◽

2016 ◽

Vol 27 (2) ◽

pp. 83-86 ◽

Cited By ~ 1

Author(s):

Razia Sultana ◽

Saiful Islam ◽

Nurjahan

Keyword(s):

Case Report ◽

Caesarean Section ◽

Ectopic Pregnancy ◽

Transvaginal Sonography ◽

Emergency Laparotomy ◽

Colour Doppler ◽

Caesarean Scar ◽

Incomplete Abortion ◽

Rare Case Report ◽

Life Threatening

Objective:The aim is to publish the case report of the rarely occurring and life threatening ectopic pregnancy developing in a Caesarean section scar causing uterine rupture.Methods and Results: This patient was diagnosed initially as a case of incomplete abortion. Other possible diagnoses were molar pregnancy, mass in the cervix. She was admitted in hospital for evacuation and curettage. During the procedure she developed severe pervaginal bleeding leading to hypovolumic shock. So decision was taken for emergency laparotomy. After opening the abdomen rupture was found in the lower uterine segment extending upto upper part of cervix. So hysterectomy was performed and histopathology confirmed the diagnosis of ectopic pregnancy that developed in a Caesarean section scar Analysis of the womens obstetric history revealed that she had been previously operated because of breech presentation.Conclusion: Heightened awareness of the possibility of pregnancy in caesarean scar and early diagnosis by means of transvaginal sonography along with colour doppler can improve outcome and minimize the need for emergency extended surgeryBangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 83-86

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Endoscopic Retrograde Cholangiopancreatography Scope‑induced Duodenojejunal Flexure Perforation: The World’s First Case

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_87_16 ◽

2017 ◽

Vol 08 (03) ◽

pp. 145-147

Author(s):

Jignesh A. Gandhi ◽

Pravin H. Shinde ◽

Basavaraj K. Nagur ◽

Rohan D. Digarse

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Primary Closure ◽

Early Recognition ◽

Emergency Laparotomy ◽

Significant Morbidity ◽

Endoscopic Retrograde ◽

The Third ◽

First Case ◽

Duodenojejunal Flexure ◽

Life Threatening

ABSTRACTDuodenojejunal (DJ) flexure perforation is very rare. DJ flexure perforation following endoscopic retrograde cholangiopancreatography (ERCP) has not be documented till date. They are associated with significant morbidity and mortality. We present an ERCP‑induced DJ flexure perforation which has been treated with primary closure in two layers at our institution. To the best of our knowledge, this is the world’s first case. Such site of ERCP‑induced perforation has not been reported in literature till date. A 75‑year‑old female patient underwent repeated ERCP for obstructive jaundice. There was perforation during the third ERCP while removing the larger stone. Emergency laparotomy was performed with primary closure of perforation in two layers. ERCP‑induced DJ flexure perforation has not yet been documented. It is potentially life‑threatening. Early recognition may lead to a better prognosis through earlier intervention.

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Cornual Pregnancy

Journal of Medicine ◽

10.3329/jom.v13i2.12763 ◽

2012 ◽

Vol 13 (2) ◽

pp. 227-229

Author(s):

F Wazed ◽

N Sultana ◽

S Ahamed ◽

JH Khan ◽

S Rouf ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Uterine Rupture ◽

Abdominal Cavity ◽

Correct Diagnosis ◽

Emergency Laparotomy ◽

Abdominal Pregnancy ◽

Cornual Pregnancy ◽

Rare Form ◽

Therapeutic Challenge ◽

Uterine Anomaly

Cornual pregnancy is rare form of ectopic pregnancy where implantation occurs in the cavity of a rudimentary horn of the uterus. It is the diagnostic and therapeutic challenge with potential sever consequence if uterine rupture occurs with massive intra abdominal haemorrhage .We report a case of misdiagnosed rupture cornual pregnancy occurring at 12 weeks gestation. First USG revealed intra uterine pregnancy. Repeat USG showed abdominal pregnancy sac but cornual pregnancy was not diagnosed and uterine anomaly was not detected. The correct diagnosis was made at emergency laparotomy. An intact pregnancy sac of 12weeks fetus was seen in abdominal cavity. Placenta and pregnancy sac was adherent to omentum and torn end of left cornu of the bicornuate uterus. Left sided cornu was resected keeping both the ovaries and tubes intact. DOI: http://dx.doi.org/10.3329/jom.v13i2.12763 J Medicine 2012; 13 : 227-229

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The Challenge of the Non-Compliant Patient: A Case of Caesarean Section Scar Ectopic Pregnancy

Surgery Case Reports ◽

10.31487/j.jscr.2021.02.01 ◽

2021 ◽

pp. 1-3

Author(s):

Jessica Audet ◽

Brittany Noel Robles ◽

Nicolle M Arroyo Lluberas ◽

Jessica Audet ◽

Daniel Faustin ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Emergency Laparotomy ◽

Pharmacological Management ◽

Compliant Patient ◽

Life Saving ◽

Close Observation ◽

Life Threatening ◽

History Of ◽

Ruptured Uterus

Ectopic pregnancy is a quite common and life-threatening pregnancy. The most common site of ectopic implantation of a fertilized embryo is the fallopian tube. In extremely rare situations, the embryo can implant in other locations, which makes the diagnosis and management even more complex. Although close observation of a new pregnancy is key in the diagnosis and treatment of an ectopic pregnancy, there is still a major risk of life-threatening outcomes. This is a case report of a 31-year-old patient with a history of multiple pregnancies who presented to a community hospital in the spring of 2021 with an ectopic caesarean scar pregnancy. A diagnosis of ectopic pregnancy was on a timely basis, and surgical management was advised. Upon refusal of treatment and admission, pharmacological management was initiated, but patient compliance challenged the success of the therapy. Patient non-compliance to close follow-up resulted in a ruptured uterus. Emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure.

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A CASE REPORT -UTERINE RUPTURE AFTER PREVIOUS CAESAREAN SECTION

EPRA International Journal of Multidisciplinary Research (IJMR) ◽

10.36713/epra6415 ◽

2021 ◽

pp. 184-186

Author(s):

Dr.Amrita Kishor Jeswani ◽

Dr.Suman Saurabh Gupta ◽

Dr.Rohit Kishor Jeswani

Keyword(s):

Caesarean Section ◽

Uterine Rupture ◽

Rare Complication ◽

Signs And Symptoms ◽

Gravid Uterus ◽

Previous Caesarean Section ◽

Risk Of Rupture ◽

Life Threatening ◽

Rupture Of Uterus ◽

Present Case Study

Uterine rupture though a rare complication is life threatening for mother as well as baby. The commonest cause for rupture of a gravid uterus is previous caesarean section. It is important that the risk of rupture of uterus is explained to the pregnant female who has undergone previous caesarean section. The symptoms with which the patient presents can be subjective and vague like pain in abdomen or of acute abdomen. The patient can also come with objective findings like non-reassuring fetal status and loss of fetal station. With previous caesarean section it is important to be vigilant throughout the pregnancy especially in third trimester. It is also imperative that the patient should be educated about the signs and symptoms of rupture uterus so that timely intervention can be done to save the life of mother and the baby. In the present case study, the USG scan revealed that the placenta had shifted and was covering the internal os from fundo-posterior position along with the shift of baby from cephalic presentation to transverse lie. Hence these case was a suspicious of rupture uterus which causes change in lie as well as presentation of baby.

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Uterine Rupture with Cesarean Scar Heterotopic Pregnancy with Survival of the Intrauterine Twin

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/6832094 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Kimberly R. Lincenberg ◽

Eric R. Behrman ◽

James S. Bembry ◽

Christine M. Kovac

Keyword(s):

Ectopic Pregnancy ◽

Uterine Rupture ◽

Placental Abruption ◽

Heterotopic Pregnancy ◽

Multiple Gestation ◽

Cesarean Scar ◽

Safe Management ◽

Life Threatening ◽

Emergent Cesarean Section ◽

Ruptured Uterus

Background. Heterotopic pregnancy is a multiple gestation with both intrauterine and ectopic fetuses. A cesarean scar ectopic pregnancy is when the fetus has implanted over the previous hysterotomy site. A known complication of cesarean scar ectopic pregnancy is uterine rupture, which can cause great morbidity and mortality. Case. 28-year-old G5P3105 at 10 weeks with a dichorionic diamniotic gestation was found to have a ruptured uterus with expulsion of a cesarean scar ectopic pregnancy and retention of the intrauterine fetus. After uterine repair, the singleton gestation reached viability was delivered by emergent cesarean section for placental abruption. Conclusion. Safe management of cesarean ectopic pregnancy requires early diagnosis by ultrasonography. With early detection, management can focus on preventing maternal morbidity of uterine rupture and life-threatening hemorrhage.

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