Abstract
BackgroundAbdominal pregnancy accounts for 0.6 to 4% of all ectopic pregnancies. Due to delays in diagnosis and difficulties in the management of abdominal pregnancy, the risk of mortality is significantly higher than for uncomplicated ectopic pregnancies.Case summaryA 23 years-old gravida-II, ectopic-I Ethiopian woman was initially managed as a case of missed second trimester abortion. Later on, abdominal ectopic pregnancy was diagnosed with ultrasound and she underwent a laparotomy. Though fetus and placenta was removed successfully without significant hemorrhage, there was inadvertent sigmoid colon injury.ConclusionIn the management of abdominal ectopic pregnancy, the possibility of bowel injury during entry to the abdominal cavity at laparotomy should always be considered and an experienced general surgeon should always be in attendance before opening the abdomen, to prevent it from happening.
Highlights
In the management of abdominal ectopic pregnancy, the possibility of bowel injury during entry to the abdominal cavity at laparotomy should always be considered and an experienced general surgeon should always be in attendance before opening the abdomen, to prevent it from happening
In contrast to tubal ectopic pregnancies, abdominal pregnancies may go undetected until an advanced gestational age
What is important and can result in potential organ injury if the necessary precautions are not taken, like the sigmoid colon injury which occurred in our case, is safe entry to the abdomen
Summary
Most of the recommendations for the management of abdominal ectopic pregnancy focus on the precautions that has to be taken in making a sound surgical examination to examine the extent of placental attachment to the surrounding tissue, after entry to the abdominal cavity. This aims to avoid massive hemorrhage and organ injury by making a good clinical judgment whether to leave the placenta in situ or remove it. We recommend that the possibility of bowel injury during entry to the abdominal cavity at laparotomy should always be considered and an experienced general surgeon should always be in attendance before opening the abdomen, to prevent it from happening. We recommend that a differential diagnosis of abdominal ectopic pregnancy should be considered and a repeat ultrasound examination should be done in any case of second trimester failed medication abortion
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