Laparoscopic Management of an Invasive Mole Perforating the Uterus.

Area of Science:

• Gynecology
• Reproductive Medicine
• Minimally Invasive Surgery

Background:

• Invasive mole, a complication of gestational trophoblastic disease, can lead to life-threatening uterine perforation.
• Previous uterine perforations by invasive moles have typically required hysterectomy.

Observation:

• A 24-year-old female presented with symptoms of uterine perforation due to an invasive mole, including abdominal pain, vaginal bleeding, and significant hemoperitoneum.
• Diagnostic imaging revealed a heterogeneous lesion on the posterior uterine wall with associated fluid.
• Laparoscopic visualization confirmed a bleeding mass within the posterior uterine wall.

Findings:

• Laparoscopic management successfully controlled active bleeding from the invasive mole perforation.
• Hemostasis was achieved through meticulous dissection, suturing, and electrocoagulation.
• Postoperative chemotherapy with methotrexate-folinic acid was administered, leading to an uneventful recovery.

Implications:

• Conservative laparoscopic management is a viable option for invasive mole-induced uterine perforation, potentially avoiding hysterectomy.
• This approach preserves fertility and reproductive capacity in affected women.
• Patients require careful monitoring for potential risks, such as future uterine rupture during pregnancy.