Management of pancreatic ectopic pregnancy

Abstract

Abdominal pregnancy is a rare and high-risk complication that ultimately requires laparotomy. Atrash et al estimated that there are 10.9 abdominal pregnancies per 100,000 births, and 9.2 abdominal pregnancies per 1000 ectopic pregnancies [1]. The most commonly reported sites of primary peritoneal implantation are the pouch of Douglas and the posterior uterine wall [2e4]. At present, we would like to report a case of pancreatic ectopic pregnancy in which laparoscopic resection of the pancreatic body and tail, and splenectomywere performed successfully without any complications. A 30-year-old, gravida 1, para 0, Chinese woman visited our unit complaining of epigastric and left abdominal pain. Her last menses was 36 days before she presented to the hospital. No contraception was used. She had no history of Pelvic Inflammatory Disease (PID), no prior Intra Uterine Device (IUD), no use of fertility drugs, and no pelvic surgery. Transvaginal ultrasound on September 12, 2014 demonstrated massive pelvic effusion (deepest point, 38 mm), and no gestational sac was detected in the uterine cavity. Her serum bhuman chorionic gonadotropin (HCG) level was 2500.09 mIU/mL, amylase was 336.8 U/L and lipase was 1671.4 U/L. Physical examination revealed stable vital signs: blood pressure of 110/70 mmHg and a pulse rate of 88 beats/min. There was no tenderness of the fornices upon vaginal examination. The patient had slight abdominal tenderness and rebound pain. A presumptive diagnosis of ectopic pregnancy complicated with acute pancreatitis was made. Later in our gynecology ward, conservative treatment was done with a single-dose methotrexate (MTX) injection (50 mg/m2). However, during the night, without a decrease in serum b-HCG level, a dramatic increase of serum amylase and abdominal tenderness were observed. The hemoglobin and hematocrit levels