Broad ligament ectopic pregnancy: a dilemma to diagnose

Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis but definitive diagnosis is made only during surgery. A 20-year-old woman with previous 2 abortions presented with acute abdomen. She had no history of amenorrhoea but there was history of two episodes of bleeding in the last month at an interval of 14 days, each episode lasting for two-three days. The last episode of bleeding was 10 days back. Her urine pregnancy test was done and it was positive. There was marked abdominal tenderness with guarding and rigidity. Per vaginal examination revealed marked tenderness in the right fornix and cervical motion tenderness, uterus size could not be assessed due to tenderness. It was diagnosed as a case of ruptured ectopic pregnancy. Since she was haemodynamically unstable, emergency laparotomy was done. She had a right sided broad ligament ectopic pregnancy which had ruptured. The tissue was completely removed and haemostatic sutures were taken. High index of clinical suspicion, early diagnosis and prompt surgery is the key to management.

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Endometrioid Carcinoma and Ectopic Pregnancy Coexisting in an Ovarian Endometrioma

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1012 ◽

2009 ◽

Vol 1 (3) ◽

pp. 63-65

Author(s):

Sabahat Rasool ◽

Tamkin Rabbani ◽

Omar S Akhtar ◽

Rana K Sherwani

Keyword(s):

Ectopic Pregnancy ◽

Pelvic Mass ◽

Histopathological Analysis ◽

Endometrioid Carcinoma ◽

Ovarian Endometrioma ◽

Β Hcg ◽

The Right ◽

Cervical Motion ◽

Cervical Motion Tenderness ◽

Urine Pregnancy Test

ABSTRACT A 28 years old female presented to our OPD with the complaints of inability to conceive for the last 13 years and a lump in abdomen for the past month. Perspeculum examination revealed a healthy cervix and vagina and a per-vaginum examination revealed a uterus that was normal in size but a lump was palpable in the right adnexa. There was no cervical motion tenderness. Routine investigations were normal. Ultrasonography showed a complex right-sided adnexal mass of 165 by 78 mm with heterogenous echotexture. Tumor markers were within normal range except serum β-hCG, which was raised. Urine pregnancy test was positive. CT scan reported a welldefined large solid-cystic moderately enhancing pelvic mass with internal septations, seemingly arising from right adnexa. The patient was taken up for a staging laparotomy. Peroperatively, the picture was suggestive of a chronic ectopic pregnancy. Histopathological analysis from the lesion showed an ovarian endometrioid carcinoma and ectopic pregnancy coexisting in the endometrioma complete surgical staging was done, followed by chemotherapy. The patient has responded well to the treatment.

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Acute presentation of ruptured ovarian cyst secondary to torsion with ipsislateral concomitant ectopic pregnancy: A case report

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v3i2.10834 ◽

2014 ◽

Vol 3 (2) ◽

pp. 54-56

Author(s):

Mahendra R Pandey ◽

Neeva Ojha

Keyword(s):

Acute Abdomen ◽

Ovarian Cyst ◽

Emergency Laparotomy ◽

Hospital Emergency ◽

Obstetrics And Gynaecology ◽

History Of ◽

Gestational Sac ◽

One Year ◽

The Right ◽

Urine Pregnancy Test

Twenty-one year unmarried regularly menstruating lady without history of amenorrhea presented with acute abdomen in TU Teaching Hospital –Emergency Department. On evaluation urine pregnancy test was positive. Urgent ultrasound revealed multiloculated cystic lesion measuring 8.5 x 8 x 6.7 cms in the right adnexa anterolateral to the uterus with no intrauterine gestational sac. She underwent emergency laparotomy with right salpingo-oophorectomy. On laparotomy there was twisted and ruptured right ovarian cyst with unruptured ampullary pregnancy on the same side. There was coexistence of these two conditions which presented as acute abdomen. DOI: http://dx.doi.org/10.3126/njog.v3i2.10834 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 54-56

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Ectopic Pregnancy Following Interval Tubal Sterilization

Journal of Lumbini Medical College ◽

10.22502/jlmc.v5i2.139 ◽

2017 ◽

Vol 5 (2) ◽

pp. 77-80

Author(s):

Deepak Shrestha ◽

Sebina Baniya ◽

Sudeep Regmi

Keyword(s):

Ectopic Pregnancy ◽

Failure Rate ◽

Uterine Cavity ◽

Prior History ◽

Emergency Laparotomy ◽

Tubal Sterilization ◽

Mobile Mass ◽

History Of ◽

Permanent Contraception ◽

Urine Pregnancy Test

Introduction: Tubal sterilization is a highly effective method of permanent contraception. However, pregnancy can still occur following a successful procedure. Published literatures report a failure rate of 0.13-1.3% and 15-33% of such pregnancies are likely to be ectopic. Case report: A 33 years para three lady with prior history of tubal ligation presented with generalized abdominal pain and several episodes of vomiting. Bimanual examination revealed a soft and mobile mass of 2 x 3 cm in right adnexa. Urine pregnancy test was positive and ultrasonogram showed a heterogeneous mass of 3.4 x 3.3 cm in right adnexa with empty uterine cavity. Culdocentesis resulted in aspiration of frank non-clotting blood. She then underwent emergency laparotomy with bilateral salpingectomy for ruptured ectopic pregnancy. Conclusion: Ectopic pregnancy after tubal sterilization though rare is not entirely impossible. All women who are offered this procedure should always be educated about its failure rate. And in women presenting with acute abdomen, a prior history of tubal sterilization doesn't preclude the possibility of ectopic pregnancy.

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H D. Ingraham. A brief report of three cases of ectopic pregnancy (New-York Medical Journal, 1892, December 31). A brief report on 3 cases of extrauterine pregnancy

Journal of obstetrics and women s diseases ◽

10.17816/jowd75420 ◽

2020 ◽

Vol 7 (5) ◽

pp. 420

Author(s):

V. Kaplyanskiy

Keyword(s):

New York ◽

Medical Journal ◽

Ectopic Pregnancy ◽

Surgical Intervention ◽

Abdominal Cavity ◽

Broad Ligament ◽

Extrauterine Pregnancy ◽

The Third ◽

First Case ◽

History Of

In the first case, the patient deliberately concealed the history of her illness, deliberately gave inconsistent data and thereby made it extremely difficult to diagnose. When the rupture of the fetal beetle in the abdominal cavity was clear, the patient resisted any surgical intervention and died. In the second case, the rupture of the fetal baby also occurred in the abdominal cavity, blood poured out, accumulated in the Douglas space, and the evacuation of the blood cyst per vaginam ended in the patient's recovery. In the third, an accidental fetus ruptured in the broad ligament and the egg now died.

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

African Health Sciences ◽

10.4314/ahs.v20i4.47 ◽

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.

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Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

Case Reports in Surgery ◽

10.1155/2019/1072821 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Oluwatobi Onafowokan ◽

Dabanjan Bandyopadhyay ◽

Dale Johnson ◽

Hugo J. R. Bonatti

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Ct Scan ◽

Late Complication ◽

Abdominal Hernia ◽

Emergency Laparotomy ◽

Incisional Hernias ◽

History Of ◽

The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

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Tendency to Ingest Foreign Bodies in Mentally Retarded Patients: A Case with Ileal Perforation Caused by the Ingestion of a Teaspoon

Case Reports in Surgery ◽

10.1155/2016/8075432 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

İhsan Yıldız ◽

Yavuz Savaş Koca ◽

Gökhan Avşar ◽

İbrahim Barut

Keyword(s):

Mental Retardation ◽

Foreign Body ◽

Foreign Bodies ◽

Mentally Retarded ◽

The Body ◽

Foreign Body Ingestion ◽

Emergency Laparotomy ◽

Ileal Perforation ◽

History Of ◽

The Right

Introduction. Unintentional foreign body ingestion commonly occurs accidentally in children aged between 3 months and 6 years and at advanced ages or results from psychiatric disorders such as hallucination in patients with mental retardation. Most of the ingested foreign bodies are naturally discharged from the body but some of them may require surgical intervention.Presentation of Case. A 29-year-old mentally retarded female patient was admitted to the emergency service with a two-day history of abdominal pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, defense, and rebound on palpation. Radiological examination revealed diffuse air-fluid levels and a radiopaque impression of a metal object in the right upper quadrant. The metal teaspoon causing ileal perforation was extracted by emergency laparotomy. On postoperative day 7, the patient was uneventfully discharged following a psychiatric consultation.Discussion. Foreign body ingestion can occur intentionally in children at developing ages and old-age patients, or adults and prisoners, whereas it may occur unintentionally in patients with mental retardation due to hallucination. However, repeated foreign body ingestion is very rare in individuals other than mentally retarded patients.Conclusion. Mentally retarded patients should be kept under close surveillance by surgeons and psychiatrists due to their tendency to ingest foreign bodies.

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Profile of Ectopic Pregnancy at Kathmandu Model Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v10i2.14328 ◽

2016 ◽

Vol 10 (2) ◽

pp. 10-13

Author(s):

HK Pradhan ◽

G Dangal ◽

A Karki ◽

R Shrestha ◽

K Bhattachan

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Discharge Summary ◽

Reproductive Age ◽

Emergency Laparotomy ◽

Average Hospital ◽

Pain Abdomen ◽

Number Of Patients ◽

History Of ◽

Age Range

Aims: The study was done to analyze the epidemiology, diagnosis and treatment aspect of patients with ectopic pregnancy at Kathmandu Model Hospital.Methods: This was a retrospective study of patients with ectopic pregnancy who received treatment at Kathmandu Model Hospital from January 2008 to September 2015. Data were analyzed from patient records and discharge summary. Delivery number was obtained from maternity record.Results: There were 61 cases of ectopic pregnancy with the hospital incidence of 1.46%. Highest number of patients 20 (32.79%) were in the age range of 28-32 years. Most of the patients were nullipara 22 (36.06%) or with parity two 20 (32.79%). Some risk factors were found in 29 (47.54%) cases. The commonest risk factor was pelvic inflammatory disease in 12 (19.67%). All presented with pain abdomen, 48 (78.68%) had per vaginal bleeding, 17 (27.87%) presented in shock. Cervival excitation was present in 38 (62.29%). Urine for pregnancy test was positive in all and 37 (60.66%) had ultrasonography. Ten (16.39%) patients underwent emergency laparoscopic surgery and 40 (65.57%) had emergency laparotomy. Salpingectomy was required in 53 (86.89%) cases. The average hospital stay was 5 days.Conclusions: The study showed that ectopic pregnancy could occur at any reproductive age without obvious risk factors. Although not all patients gave history of amenorrhoea, pain abdomen was present in all.

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Hepatic angiosarcoma

Revista de Medicina ◽

10.11606/issn.1679-9836.v97i6p578-580 ◽

2018 ◽

Vol 97 (6) ◽

pp. 578-580

Author(s):

Vivian Nunes Arruda ◽

Melissa De Andrade ◽

Rhafir Gonçalves

Keyword(s):

Clinical Manifestations ◽

Pulmonary Nodules ◽

Emergency Laparotomy ◽

Abdominal Ultrasonography ◽

Reactive Protein ◽

Hepatic Angiosarcoma ◽

History Of ◽

Rare Malignancy ◽

Pathology Reports ◽

The Right

Hepatic Angiosarcoma is a rare malignancy of endothelial cell origin that is generally idiopathic and presents non-specific clinical manifestations. Hemoperitoneum can occur in 17-27% of cases and is a result of tumor rupture, which has a devastating prognosis. We present a 79-year-old female patient with history of diffuse right upper quadrant abdominal pain associated with syncope episodes and unintentional weight loss. Physical examination was unremarkable except for painful palpation of the right upper quadrant. Laboratory exams indicated chronic disease anemia, a 2.7 INR, decreased albumin, increased C-Reactive Protein and GGT, and normal AST, ALT, Alkaline Phosphatase and Bilirubin. Viral hepatitis serologies were negative. Abdominal ultrasonography revealed hepatomegaly and solid liver lesions of heterogeneous echogenicity and imprecise limits. Three-phase abdominal CT showed multiple liver masses of heterogeneous pattern of enhancement suggestive of atypical hemangioma associated with ascites. Chest CT revealed bilateral pulmonary nodules suggestive of metastasis. During hospital stay, the patient developed a massive hemoperitoneum that required emergency laparotomy. In this circumstance, liver and omentum biopsies were performed and the pathology reports ultimately indicated the possibility of hepatic angiosarcoma. The patient developed refractory hemoperitoneum and hemorrhagic shock and ultimately passed away, 48 days after hospital admission. Definitive diagnosis was only available posteriorly, with immunohistochemistry positivity for ERG, CD34 and Factor VIII-related antigen on both omentum and lung samples. This case study provides valuable clinical discussion and emphasizes how a transdisciplinary approach is essential to correctly diagnose and manage such complex cases.

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Rare Contents of an Internal Hernia through a Defect of the Broad Ligament of the Uterus

Case Reports in Surgery ◽

10.1155/2021/5535162 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Masafumi Takahashi ◽

Masanori Yoshimitsu ◽

Takuya Yano ◽

Hitoshi Idani ◽

Shigehiro Shiozaki ◽

...

Keyword(s):

Fallopian Tube ◽

Internal Hernia ◽

Closed Loop ◽

Broad Ligament ◽

Definitive Diagnosis ◽

Ileal Loop ◽

History Of ◽

The Right ◽

Rare Hernia ◽

Bowel Herniation

Herniation through a defect of the uterine broad ligament is a rare internal hernia that is difficult to diagnose definitively. Common hernia contents contain ileal loops. Herein, we report a rare case of internal herniation of both the ileum and fallopian tube through a defect of the broad ligament. A 52-year-old woman presented to our hospital with suprapubic pain and vomiting. She had a history of bowel obstruction following cesarean section. On abdominopelvic computed tomography, we suspected a closed-loop obstruction associated with bowel herniation in the right broad ligament. However, we could not identify an area of poor enhancement adjacent to distended small intestines. Emergency laparoscopic exploration revealed a viable ileal loop and incarcerated organ. Therefore, we switched to laparotomy that revealed the right fallopian tube as the ischemic organ. We reduced the hernia, resected necrotic right fallopian tube, and closed the defect of the broad ligament. The patient had an uneventful postoperative course. Rare hernia contents might complicate preoperative clinical diagnosis. Laparoscopy is useful for establishing a definitive diagnosis and treating broad ligament hernias.

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