scholarly journals Heterotopic pregnancy: a case report

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Tamer Ali ◽  
Mohamed A. Tawab ◽  
Mona Abdel Ghaffar ElHariri ◽  
Alaa A. Ayad
Keyword(s):  
Abdominal Pain ◽  
Adnexal Mass ◽  
Stable Condition ◽  
Lower Abdominal Pain ◽  
Rare Condition ◽  
First Trimester ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Laboratory Findings ◽  
The Right

Abstract Background Heterotopic pregnancy describes the occurrence of two pregnancies in different implantation sites simultaneously, which is rare, yet it is a challenge to diagnose such a problem due to complex clinical and laboratory findings. In the current study, we present a case of first trimester heterotopic pregnancy diagnosed by ultrasound (US) and magnetic resonance imaging (MRI) and was managed successfully. Case presentation A 22-year-old primigravida lady with spontaneous pregnancy was presented by increasing lower abdominal pain for 5 days with brownish vaginal discharge, nausea, and vomiting episodes. Trans-abdominal and endovaginal ultrasound was performed and revealed a viable intrauterine pregnancy of 8 weeks and 1 day, associated with a heterogeneous complex right adnexal mass. MR imaging revealed a right adnexal mass intimately anterior to the normal right ovary. Laparascopy was done; it revealed a distended right fallopian tube with pregnancy while the right ovary was not seen (impeded in the pouch of Douglas), and right salpingectomy was done. The specimen was sent for histopathology. The patient tolerated the procedure well and was then taken to the recovery room in stable condition. The histopathological report confirmed the diagnosis of ectopic pregnancy. Conclusion However, heterotopic is a rare condition, any pregnant woman presenting with alarming abdominal pain and adnexal abnormality; heterotopic pregnancy should be among the differential diagnosis possibilities. The patient should be thoroughly investigated using ultrasound and MRI if needed, to exclude this rare diagnosis and allow on-time proper management.

HETEROTOPIC PREGNANCY WITH INEVITABLE ABORTION (RIGHT ADNEXAL LIVE ECTOPIC AND COEXISTING INTRAUTERINE TRIPLETS WITH ABSENT FETAL CARDIAC ACTIVITY)

2021 ◽  
pp. 58-59
Author(s):  
Jayanta Sarkar ◽  
Mini Sengupta
Keyword(s):  
Ectopic Pregnancy ◽  
Abdominal Cavity ◽  
Lower Abdominal Pain ◽  
Cardiac Activity ◽  
Exploratory Laparotomy ◽  
Sudden Onset ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Short Period ◽  
The Right

Heterotopic pregnancy describes the occurrence of two or more pregnancies in different implantation sites simultaneously, intrauterine pregnancy coexists withectopic pregnancies (ampullary in 80%). A 27-year-old women (P ,L1) presented to the emergency department with a complaint of sudden onset of right-sided lower abdominal pain with 1+1 vaginal bleeding and had a short period of Amenorrhea. Ultrasonography demonstrated three intrauterine gestational sacwith foetal pole noted but Cardiac activity was absent . The right adnexa showed a heteroechoic area andmoderate amount of free uid was present in the lower abdominal cavity. Ectopic pregnancy was disturbed. An emergency exploratory laparotomy was performed under general anesthesia. Haemoperitoneum was found with a ruptured righttubal ectopic pregnancy as well. Both the ovaries appeared normaland a corpus luteal cyst was presentin right ovary. Right sided salpingectomy was performed with removal of the ectopic mass,heamostasis secured ,on table blood transfusion had been given.Suction evacuation had also been performed by manual vacuum aspirationon same sitting.Both the specimen send for histopathology. Histology conrmedGestational sac suggestive of an intra uterine pregnancy coexists with ectopic pregnancy. Left tube and both ovaries were found healthy. Episodes of PID also have a strong correlation with occurrence of ectopic gestation. Once diagnosis of heterotrophic pregnancy has been made the management is essentially surgical.

scholarly journals Diagnosis of Heterotopic Pregnancy Using Ultrasound and Magnetic Resonance Imaging in the First Trimester of Pregnancy: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Sue Yazaki Sun ◽  
Edward Araujo Júnior ◽  
Julio Elito Júnior ◽  
Liliam Cristine Rolo ◽  
Felipe Favorette Campanharo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Power Doppler ◽  
Uterine Cavity ◽  
Lower Abdominal Pain ◽  
First Trimester ◽  
Heterotopic Pregnancy ◽  
Resonance Imaging ◽  
Good Continuation ◽  
Intrauterine Pregnancy

Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos into the uterine cavity while another one is implanted ectopically, particularly into the uterine tube. Its occurrence has increased drastically over the last few years due to assisted reproduction procedures. In general, the diagnosis is made during the first trimester by using endovaginal two-dimensional ultrasound (2DUS), through observing a complex para- or retrouterine mass in association with a viable uterine pregnancy. However, under some conditions such as atypical ultrasonographic presentations, 2DUS does not clarify the situation whereas magnetic resonance imaging (MRI) of the pelvis is able to do so. We present the case of a pregnant woman in her fifth pregnancy, with a clinical condition of lower abdominal pain and pallor. Endovaginal 2DUS showed a complex voluminous mass in the left pelvic region in association with a viable intrauterine pregnancy. 2DUS in power Doppler mode showed “ring” vascularization, compatible with an ectopic gestational sac. MRI was of great importance in that it suggested that the mass had hematic content, which together with the clinical features, indicated that laparotomy should be performed. This surgical choice was essential for the woman to achieve a clinical improvement and for good continuation of the intrauterine pregnancy.

scholarly journals Heterotopic Pregnancy: A Clinical Case Report

1970 ◽  
Vol 39 (3) ◽  
Author(s):  
S Chowdhury ◽  
T Chowdhury
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ectopic Pregnancy ◽  
Clinical Examination ◽  
Clinical Case ◽  
Lower Abdominal Pain ◽  
Tubal Pregnancy ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Ectopic Pregnancies

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)

scholarly journals A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Kajdy ◽  
Katarzyna Muzyka-Placzyńska ◽  
Dagmara Filipecka-Tyczka ◽  
Jan Modzelewski ◽  
Marek Stańczyk ◽  
...  
Keyword(s):  
Gestational Age ◽  
Abdominal Cavity ◽  
Uterine Cavity ◽  
Rare Condition ◽  
Exploratory Laparotomy ◽  
First Trimester ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Intrauterine Pregnancy ◽  
Unique Case

Abstract Background Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester. Case presentation We present a unique case of HP diagnosed at 26 weeks of spontaneous pregnancy in a patient without any relevant risk factors. We performed an extensive review of HP cases from MEDLINE (PUBMED) published in English between 2005-2019 to prove this case's uniqueness. A 24-year-old woman presented because of threatened preterm birth. Despite treatment, pain aggravated, without progression of labor. An emergency ultrasound exam revealed free fluid in the abdominal cavity. Suspicion of active bleeding prompted the medical team to perform an exploratory laparotomy. The surgery team found a ruptured heterotopic pregnancy. This was an unexpected cause of nontraumatic hemoperitoneum at such advanced gestational age. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. The final review included 86 out of 124 records. A total number of 509 cases were identified, but not all of them had complete data. The maximum reported gestational age at the time of diagnosis was 16 weeks of pregnancy, while our case became symptomatic and was diagnosed at 26 weeks of pregnancy. Conclusions Regardless of pregnancy age, HP can be a cause of hemoperitoneum, and it should be included in the differential diagnosis of acute abdomen in the second trimester.

scholarly journals Ectopic pregnancy in the ampulla of the fallopian tube at 16 gestational weeks: lessons from a case report

2020 ◽  
Vol 20 (4) ◽  
pp. 1895-7
Author(s):  
Nnabuike Chibuoke Ngene ◽  
Ongombe Lunda
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Haemoglobin Concentration ◽  
Lower Abdominal Pain ◽  
First Trimester ◽  
Tubal Pregnancy ◽  
Emergency Laparotomy ◽  
History Of ◽  
The Right

Background: It is uncommon to find ampullary tubal pregnancy in the second trimester. Methods: A 35-year-old G4P3 at 16 gestational weeks presented with a day history of sudden severe lower abdominal pain and no vaginal bleeding. The patient had a normal pulse of 82/minutes, haemoglobin concentration of 6.3 g/dl and ultrasonography showed an empty uterus with an alive fetus in the right adnexa. She was provisionally diagnosed to have an abdominal pregnancy. Results: The patient had an emergency laparotomy where 2.2 L of haemoperitoneum and a slow-leaking right ampullary tubal pregnancy were found. Right total salpingectomy was performed and she had an uncomplicated post-operative fol- low-up. Histology of the lesion confirmed tubal pregnancy. Conclusion: The growth of a pregnancy in the ampulla beyond the first trimester is possibly due to increased thickness and or distensibility of the fallopian tube. A tubal pregnancy may present with a normal pulse despite significant haemorrhage. Keywords: Abdominal pain; ampullary tubal ectopic pregnancy; Bezold–Jarish-like reflex.

scholarly journals Roberts uterus: a rare congenital anomaly

2017 ◽  
Vol 6 (12) ◽  
pp. 5657
Author(s):  
Nagendra Sardeshpande ◽  
Pratima Chipalkatti ◽  
Jainesh Doctor
Keyword(s):  
Congenital Anomaly ◽  
Abdominal Pain ◽  
Adnexal Mass ◽  
Lower Abdominal Pain ◽  
Uterine Horn ◽  
Transabdominal Ultrasound ◽  
Septate Uterus ◽  
Bicornuate Uterus ◽  
Rare Congenital Anomaly ◽  
Hysteroscopic Resection

A 23-year-old girl presented with severe cyclical lower abdominal pain during menstruation since menarche, which had increased since the last 4 years. Transabdominal ultrasound showed adnexal mass with no internal vascularity; MRI reported it as bicornuate uterus with one non-communicating right uterine horn with haematometra. On hysteroscopy there was evidence of septate uterus communicating only to the left ostia. Ultrasonography-guided hysteroscopic resection of septa with drainage of haematometra was done. Patient is presently asymptomatic.

scholarly journals Thrombophlebitis of the Right Renal Capsular Vein during the Early Postpartum Period

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Koji Nakamura ◽  
Kensuke Nakanishi ◽  
Satoshi Kubota ◽  
Ryoko Takahashi ◽  
Mari Tomiie ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Postpartum Period ◽  
Anticoagulation Therapy ◽  
Lower Abdominal Pain ◽  
Postpartum Woman ◽  
Ovarian Vein ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
The Right ◽  
Contrast Ct

Venous thrombophlebitis is an uncommon cause of fever and lower abdominal pain during the early postpartum period. It mostly occurs in the right ovarian vein, and computed tomography (CT) is useful for diagnosis. We present a case of thrombophlebitis of the renal capsular vein. A 27-year-old postpartum woman presented with right lower abdominal pain and fever unresponsive to antibiotics. Contrast CT showed a ring-enhancing mass in the right retroperitoneum, which was distinct from the right ovarian vein. Exploratory laparoscopy revealed a retroperitoneal hematoma and normal appendix. Reconstruction of CT images revealed that the mass was connected to the right renal capsular vein. Anticoagulation therapy improved the patient’s symptoms. Postpartum thrombophlebitis can occur at locations other than the ovarian vein, such as the renal capsular vein. If a retroperitoneal mass is discovered during puerperium, a thorough investigation of the mass’s continuity with surrounding vessels is essential to avoid unnecessary surgery.

Spontaneous heterotopic triplet pregnancy with intrauterine monochorionic-monoamnionic twins

2016 ◽  
Vol 5 (2) ◽  
pp. 117-119
Author(s):  
Alexander Kotlyar ◽  
Jennifer Eaton ◽  
Katherine Singh ◽  
Uma Perni
Keyword(s):  
Abdominal Pain ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Heterotopic Pregnancy ◽  
Second Trimester ◽  
Triplet Pregnancy ◽  
Intrauterine Pregnancy ◽  
Chorionic Villi ◽  
Prior Use ◽  
Unusual Phenomenon

Abstract Heterotopic pregnancies are an unusual phenomenon, which have recently become more prevalent with assisted reproductive technologies (ART). Triplets that are part of a heterotopic pregnancy are exceedingly rare. Here, we describe a case of a woman who presented at 15+1 weeks of gestational age with a known monochorionic-monoamniotic intrauterine pregnancy with several days of abdominal pain with an otherwise unremarkable gastrointestinal (GI) assessment. Salpingectomy was performed, and pathology revealed chorionic villi within the fallopian tube consistent with a heterotopic triplet pregnancy. This pregnancy was conceived spontaneously. Even without the prior use of ART, physicians need to be aware of the risk of heterotopic pregnancy in a patient with a known twin gestation. In addition, this case highlights how heterotopic triplets can present even within the second trimester.

scholarly journals SAT-380 A Case of Primary Hyperparathyroidism on the Third Trimester of Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Alexandra Carranceja Villapol ◽  
Maria Princess L Kanapi
Keyword(s):  
Blood Pressure ◽  
Abdominal Pain ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Elevated Serum ◽  
Stable Condition ◽  
Abdominal Ultrasound ◽  
Pressure Control ◽  
Ibandronic Acid ◽  
The Right

Abstract Introduction: This is the case of a pregnant woman on her 3rd trimester who was diagnosed with primary hyperparathyroidism. Since there are two patients involved, the potential complications that can be brought about by the diagnostic tests and the treatment had to be weighed against the benefits. Case: The patient is SA, a 34-year old female on her 29th week of pregnancy, admitted due to a month history of abdominal pain described as intermittent, crampy, generalized, non-radiating, and mild-to-moderately severe in intensity. She was advised to do tests but did not comply. In the interim, there was recurrence of symptoms but with resolution. However, the crampy abdominal pain recurred, now localized at the right upper quadrant and epigastric areas, radiating to the right upper back, moderate in intensity, and with associated nausea and vomiting, leading to admission. She was first managed under OB-Gynecology, given hydration, pain management and Betamethasone. She was also referred to Cardiology for blood pressure control, and Surgery for evaluation of the abdominal pain. Due to an increasing trend of her blood glucose, she was referred to Endocrinology and started on insulin. Mild bilateral nephrocalcinoses seen in an abdominal ultrasound prompted work-up showing an elevated serum ionized calcium at 1.88 meq/L (n 1.12-1.32 meq/L), elevated intact PTH at 451.13 pg/ml (n <67.9 pg/ml), and low Vitamin D at 10.96 ng/ml (n >30ng/ml). Parathyroid ultrasound showed nonthyroidal tissue measuring 0.4 x 0.6 cm at the right inferior area. Saline hydration and diuresis with Furosemide were started to manage the hypercalcemia. A multi-disciplinary meeting was held to discuss the options for management and risks involved. The goal was to deliver the baby in stable condition possibly to term, while keeping maternal calcium levels and blood pressure normal. However on her 30th week of gestation, she had persistent elevated blood pressure and underwent emergency caesarian section. After delivery, the patient was advised against breastfeeding for adequate management of her hypercalcemia. She was started on Cinacalcet, Calcitonin, and Ibandronic Acid. A Parathyroid Sestamibi Scan done showed a parathyroid adenoma on the right inferior lobe, and she underwent right inferior parathyroidectomy, with left thyroidectomy and isthmusectomy. Findings showed a right inferior parathyroid adenoma and a benign follicular nodule on the left thyroid. She was started on Calcium Carbonate and Calcitriol, and discharged stable. Conclusions: This case shows that when two lives are at stake every step of the management, whether diagnostic or therapeutic, must be communicated well to the patient and to the other members of the team. It is ultimately a choice made by the expectant mother but through the proper guidance and updated knowledge of the team, combined with a good clinical eye especially in the treatment of pregnant women.

Ileoscopy in the Diagnosis of lleal Lymphosarcoma

PEDIATRICS ◽  
1975 ◽  
Vol 56 (1) ◽  
pp. 127-129
Author(s):  
Seymour Katz ◽  
Irwin Katzka ◽  
Keith Schneider ◽  
Mervin Silverberg
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Gastrointestinal Tract ◽  
Inflammatory Process ◽  
Lower Abdominal Pain ◽  
Recurrent Abdominal Pain ◽  
Neoplastic Disease ◽  
Direct Visualization ◽  
Appendiceal Abscess ◽  
The Right

Recent advances in flexible fiberoptic endoscopy have permitted direct visualization of segments of the gastrointestinal tract hitherto considered inaccessible. Preoperative diagnoses of diseases of these areas are subject to the vagaries of roentgen interpretation. The following case report illustrates the value of the colonoscope in distinguishing intralumenal ileal neoplastic disease from an inflammatory process (e.g., ileitis, appendiceal abscess). CASE REPORT W. M., a 15-year-old white youth, was referred for eveluation of intermittent lower abdominal pain of six weeks' duration. Prior to his admission, he experienced cramping abdominal pain, fever, cough, emesis, and diarrhea. This gradually abated, leaving a residuum of recurrent abdominal pain which was relieved partially with fiexion of the right thigh.

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