A primary omental pregnancy after unilateral salpingectomy and unilateral tubal ligation

Abstract

In this research letter we want to emphasize the variety of ectopic pregnancy and bring omental pregnancy to the attention of clinicians. A 31-year-old gravida 2, para 0 woman presented with acute lower abdominal pain, which was accompanied by vomiting, dizziness, and 3-day delayed menstruation. She was admitted to the Emergency Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangzhou, China). In the previous year, she had undergone a right salpingectomy because of right fallopian ectopic gestation, and her left fallopian tube was ligated during the surgery. Abdominal palpation revealed shifting dullness and mild tenderness in the lower abdomen. Transvaginal ultrasound showed no evidence of intrauterine pregnancy, but detected abundant fluid in the pouch of Douglas. The serum beta-human chorionic gonadotropin (b-HCG) level was 1432 IU/L. We determined a provisional diagnosis of ruptured ectopic pregnancy. After aspirating 2000 mL of blood, the uterus was of normal size with no sign of a uteroperitoneal fistula. The right fallopian tube was absent and the left fallopian tube was separated from the isthmus with the fimbriated extremity blocked. The bilateral ovaries had a normal shape. Further exploration of the abdomen showed a 5 cm 4 cm lesion covered by large clots in the lower left omentum. An active bleeding site appeared after the clots were removed. She underwent a partial omentectomy, which was followed by dilatation and curettage. Histopathological assessment indicated chorionic villus embedded in the omentum tissue with surrounding hemorrhage and a syncytiotrophoblast (Figure 1). The tissue curetted from the