Intraligamentary Pregnancy with Recurrent Urine Retention: Case Report

Salma Abdi Mahmoud,Osman Saia,Adam Munkaila,Mumuni Kareem,Ali Said Yussuf,Chukwuma J Okafor,Ali M Ussi,Gumanga Solomon

doi:10.4236/ojog.2021.115048

Abstract

An intraligamentary pregnancy is an extremely rare form of ectopic pregnancy, with only a few cases reported. We report a 20-year-old woman who had an ongoing pregnancy at about 22 weeks gestation, consulted for recurrent urinary retention and severe lower abdominal pain of two days duration. Pelvic ultrasonography revealed an extrauterine gestation of 19 weeks and four days on the left adnexal region. Exploratory laparotomy was performed that found left intraligamentary pregnancy (unruptured) measured 20 - 25 cm across, attached posteriorly to the bowel (sigmoid colon) and extended to the pouch of douglas impinging on the bladder base. Resection of ectopic pregnancy was successfully performed, urine retention resolved, and the patient was discharged with no postoperative complications. Early recognition of this rare form of ectopic gestation is of considerable importance because of the risk of a life-threatening haemorrhagic complication necessitating emergency surgical intervention.

Highlights

IntroductionIntraligamentary gestation is boarded anteriorly and posteriorly by the leaves of the broad ligament, medially by the uterus and laterally by the pelvic side wall, inferiorly by the pelvic floor, and superiorly by the fallopian tubes
Exploratory laparotomy was performed that found left intraligamentary pregnancy measured 20 - 25 cm across, attached posteriorly to the bowel and extended to the pouch of douglas impinging on the bladder base
The prerequisites for the development of intraligamentary pregnancy are; the expanding gestational sac must split the oviduct precisely between the leaves of the broad ligament, the amnion at least must remain intact to permit the fetus to continue to grow in the extraperitoneal sac, and rupture must occur early enough so that the villi are capable of expanding their areas of nidation [4] [5]

Summary

Introduction

Intraligamentary gestation is boarded anteriorly and posteriorly by the leaves of the broad ligament, medially by the uterus and laterally by the pelvic side wall, inferiorly by the pelvic floor, and superiorly by the fallopian tubes. It is an abdominal pregnancy that develops retroperitoneally [3]. The prerequisites for the development of intraligamentary pregnancy are; the expanding gestational sac must split the oviduct precisely between the leaves of the broad ligament, the amnion at least must remain intact to permit the fetus to continue to grow in the extraperitoneal sac, and rupture must occur early enough so that the villi are capable of expanding their areas of nidation [4] [5]. We report a case of intraligamentary pregnancy with recurrent urine retention diagnosed and successful managed by exploratory laparotomy

Case Report

Discussion

Findings

Conclusion