Laparoscopic management of primary abdominal pregnancy: a case report

This is a case report of a primary abdominal pregnancy managed by laparoscopic intervention. A 22 year old, gravida 1, woman was admitted to our emergency room with vaginal bleeding and pain in lower abdomen. She was 4 weeks pregnant according to her last menstrual period. She had undergone right salpingoophorectomy previously. Pelvic examination revealed cervical motion tenderness, bilateral adnexal tenderness and rebound tenderness. Her vital signs were normal. Beta hCG was 15826 IU/ml and hemoglobin was 10.0 g/dl. Transvaginal sonography showed an endometrium of 3 mm thickness and free fluid in the pelvis. Upon admission to the Early Pregnancy Clinic, abdominal pain became worse and hemoglobin decreased to 8.0 g/dL. Therefore, we performed a laparoscopy which showed that the uterus, left tube and ovary were completely normal with absence of the right ovary and tube. Approximately 500 cc blood was aspirated from the pelvis. Between the right sacrouterine ligament and rectum, there was a bleeding area 2 cm in width which was removed with forceps and sent for frozen pathological examination,which revealed 'placental tissue fragments'. Endometrial sampling was reported to be 'secretory endometrium'. A rapid decrease in the beta HCG post operative titer confirmed the resolution of the pregnancy. Primary abdominal pregnancy is extremely rare. The diagnosis is confirmed according to Studdiford's criteria. In the literature, there only a few cases of abdominal pregnancy in which laparoscopic procedure has been used effectively as treatment. However, laparoscopic procedure is usually successful in treatment of abdominal pregnancy if the gestational age is early enough.