Laparoscopic Management of an Abdominal Ectopic Pregnancy

Abstract

<h3>Study Objective</h3> To describe the diagnostic challenge and laparoscopic management of an ectopic abdominal pregnancy. <h3>Design</h3> Clinical history, brief literature review, and video documentation. <h3>Setting</h3> Patient was placed in dorsal lithotomy for the laparoscopic resection of an abdominal ectopic pregnancy in a tertiary care centre. <h3>Patients or Participants</h3> The patient was a 39-yo G5P2 female presenting with a live 11-week abdominal ectopic pregnancy. We demonstrate the diagnostic challenge of this rare presentation with clearly labelled ultrasound and MRI images. Due to the high morbidity and mortality associated with abdominal ectopic pregnancies, intra-sac potassium chloride was administered in conjunction with systemic methrotrexate. Repeat imaging months after initial treatment revealed significant persistent pregnancy tissue intimately involved with the bladder and bowel. The patient was consented for a laparoscopic removal of abdominal ectopic pregnancy. <h3>Interventions</h3> Laparoscopy. <h3>Measurements and Main Results</h3> Diagnostic laparoscopy was undertaken where pelvic inspection revealed the large bowel to be completely adherent to the underlying uterus and abdominal pregnancy. Anatomy was severely distorted, and the bladder could be seen significantly adherent anteriorly. Careful step-by-step dissection with well labelled diagrams demonstrated the isolation of the abdominal ectopic pregnancy from surrounding organs. The abdominal pregnancy was confirmed by revealing macerated skeletal tissue confined to a pseudosac located anterior to the uterus and posterior to the bladder. We utilized energy, sharp, and blunt dissection to reveal landmark anatomical structures and progressively restore an initially unrecognizable pelvis to a mobile uterus and free posterior cul-de-sac. <h3>Conclusion</h3> Abdominal ectopic pregnancies are rare and pose a diagnostic challenge. Complications are common with high morbidity and mortality to both mother and fetus, thus resection is often recommended. We demonstrate that laparoscopy is a safe and feasible option to manage such pregnancies.