Primary Omental Pregnancy Research Articles

Primary omental pregnancy after in vitro fertilization complicated by hemoperitoneum—how to manage it laparoscopically

To report an uncommon case of primary OP treated laparoscopically. Ectopic pregnancy (EP) is the leading cause of maternal mortality during the first trimester and the incidence increases with assisted reproductive techniques, occurring in approximately 1.5%-2.1% of patients undergoing invitro fertilization.1 Omental pregnancy (OP) is an extremely rare form of EP accounting for less than 1% of all EPs. OP can be classified as primary or secondary on the basis of Studdiford's criteria2. The preoperative diagnosis of OP is complex and usually occur in acute circumstances during a throughout intraoperative evaluation of the abdomen.3-5 A delayed diagnosis poses a serious threat to the survival of the patient; therefore, it is important to remark that EP can exist in unusual locations and prompt surgical intervention may be necessary. A step-by-step narrated video of a rare clinical case and description of the surgical procedure. Tertiary Level Academic Hospital "IRCCS Azienda Ospedaliero - Universitaria di Bologna" Bologna, Italy. A 36-year-old woman was referred to our emergency room because of acute abdominal pain and nausea for 2 hours with no signs of hemodynamic instability. The patient also complained that poor vaginal bleeding appeared during the last 24 hours. The patient has undergone a cycle of invitro fertilization with an elective single frozen embryo transfer of a blastocyst on day 5, 2 months before. She had no relevant clinical or surgical history. Diffuse abdominal tenderness and a painful uterus at mobilization were appreciated at clinical examination. A massive hemoperitoneum was diagnosed using transvaginal-transabdominal ultrasound, and no uterine or adnexal lesions were identified. The β-human chronic gonadotropin level was 43.861 mIU/mL, and the hemoglobin value was 10.5 g/dL. On suspicion of a ruptured EP, after detailed counseling and the acquisition of informed consent, a laparoscopic exploration was planned. First, the hemoperitoneum was evacuated to allow visualization of the abdominal cavity. At pelvic inspection, no EP was found. Throughout the exploration of the abdominal cavity, a 4-cm bluish cystic mass of friable consistency was detected infiltrating the omentum and the mesentery. According to Studdiford's criteria, the diagnosis of a primary OP was established. A careful and complete excision of the ectopic implant was performed with an ultrasonic system and required a considerable hemostatic effort using bipolar energy, endoscopic clips, and mechanical compression. The postoperative course was uneventful. The β-human chronic gonadotropin levels gradually decreased to negative values within 29 days after surgery. Omental ectopic pregnancy can be successfully managed with a laparoscopic approach even in an emergency setting. Omental pregnancy can easily be overlooked, even by skilled surgeons, during laparoscopic exploration. It is mandatory that all peritoneal surfaces and the omentum be carefully inspected during surgery in patients without other signs of pelvic EP.We confirm that the patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites.

Primary omental pregnancy in a subseptate uterus: A novel case report and literature review

Introduction and Importance: Ectopic pregnancy is defined as a pregnancy in which the fertilized ovum implants itself in a location other than the uterine endometrium. Abdominal ectopic pregnancies involve the implantation and development of the embryo within the peritoneal cavity. Primary omental pregnancies are the rarest form of abdominal pregnancy and possibly the rarest extrauterine gestation. Case Presentation: We report the first case of a primary omental pregnancy in a subseptate uterus in literature. Our patient, a 33-year-old female, G8P4+3, presented with nausea, severe abdominal pain, and vaginal spotting at 6 weeks’ gestational age. She had mild tenderness below the umbilicus, with positive cervical and right adnexal tenderness. 2D-ultrasound revealed a subseptate uterus, normal ovaries and fallopian tubes, absence of a gestational sac, and a 4×3×2.5 cm mass in the right adnexa. A mini-laparotomy was performed due to suspicion of ruptured tubal pregnancy, revealing a primary omental pregnancy which was managed via partial omentectomy. Clinical Discussion: Ectopic pregnancies have ambiguous presentations, however correct diagnosis and management is crucial to prevent complications. A high index of suspicion must be exercised to make an accurate diagnosis of primary omental pregnancy. A subseptate uterus is a subtype of the most common uterine anomaly and should be investigated via 3D-ultrasound and magnetic resonance imaging as it causes increased risk of primary omental implantation. Conclusion: Correct identification of subseptate or septate uteri is vital. Greater research is needed to elucidate the association between septate or subseptate uteri and ectopic pregnancy, particularly primary omental pregnancy.

OMENTAL PREGNANCY: REPORT CASE AND LITERATURE REVIEW

Objective: Abdominal pregnancy is a rare form of ectopic pregnancy with very high morbidity and mortality for both the mother and the fetus. Diagnosis and management can pose some difficulties especially in low-resource centers. The objective of this stady is to illustrate the different epidemiological, clinical and therapeutic data of abdominal pregnancy. Patient and observation: We present an additional case of primary omental pregnancy at 12 gestational weeks presenting with symptoms of hemoperitoneum and acute abdomen. Pregnancy status was confirmed after admission. Transvaginal ultrasound examination revealed a single viable fetus with a large amount of free peritoneal fluid, but no intrauterine sac or adnexal mass Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact omental pregnancy was detected and partial omentectomy was performed. Conclusion: Early diagnostic of omental pregnancy is difficult but essential to reduce the high mortality.

English

English

Primary Omental Ectopic Pregnancy: A Rare Disease Not to be Missed

Omental pregnancy is the least common form of abdominal pregnancy. We present a rare case of primary omental pregnancy where patient presented with typical clinical feature of ectopic pregnancy. Trans-vaginal scan revealed an empty uterus with presence of adnexal mass. Fetal echo and fetal heart activity were seen within the mass. However, bilateral fallopian tubes and ovaries appeared to be normal. Part of the omentum was resected to remove a suspicious looking mass, which turned out to be an omental pregnancy.

A primary omental pregnancy after unilateral salpingectomy and unilateral tubal ligation

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

Primary Omental Pregnancy: Successful Laparoendoscopic Single-site Partial Omentectomy After Diagnosis by Diffusion-weighted Magnetic Resonance Imaging

A 34-year-old, gravida 2, para 0 woman was referred after 8 weeks of amenorrhea. Serum b-human chorionic gonadotropin value was 828 mIU/mL. Diffusion-weighted magnetic resonance imaging (MRI) [1] showed a hematoma-like mass with heterogeneous signal intensities, adjacent to the omental fat, in the retrovesical space, along with corpus lutein cyst of left ovary (Fig. 1, A and B). Emergency laparoendoscopic single-site (LESS) [1] partial omentectomy was performed because of difficult dissection of the firmly attached gestational mass from the omental tissue (Fig. 1C). Histopathologic examination of the excised specimen confirmed primary omental pregnancy by showing the chorionic villi with direct invasion of trophoblast to the omental fat tissue (Fig. 1D). Primary omental pregnancy, in which the fertilized ovum directly implants into the omental tissue [2], is a less common form of abdominal pregnancy [3]. Precise preoperative evaluation by diffusion-weighted MRI accelerates the successful minimally invasive management by LESS surgery.

Successful laparoscopic management of a primary omental pregnancy: Case report and review of literature

A 32-year-old gravid 1, parity 0 woman was referred to our hospital with suspicion of ectopic pregnancy 31 days after her previous menstrual period. She had a 5-month history of secondary infertility reported increasing lower abdominal pain. Her serum human chronic gonadotropin level was 8160 mIU/mL. Her medical history was significant for a myomectomy and an enucleation of left ovarian cyst. On suspicion of an ectopic pregnancy, laparoscopic exploration was performed. Dense pelvic adhesion was seen. After dissection of the adhesion, we could not find the blastocyst in her pelvis. Early pregnancy tissue implanted in the omentum was identified and was excised laparoscopically. The postoperative course was uneventful. When no ectopia is found in the fallopian tubes during laparoscopy or laparotomy for ectopic pregnancy, all peritoneal surfaces and the omentum must be carefully inspected during surgery.

Neglected Primary Omental Pregnancy after Laparoscopic and Medical Treatment: A Difficult Diagnosis?

The following case report describes a rare case of omental pregnancy in a fertile 34-year-old woman at 5 + 3 weeks of gestation who presented with abdominal pain. Clinical examination, vital signs, and laboratory values were within normal limits, so the woman was hospitalized and monitored. Laparoscopic exploration was performed according to the preoperative diagnosis of tubal pregnancy, but it showed normal pelvic organs. In view of the growth of the β-HCG value, a medical approach was attempted, without success. Due to hemodynamic instability, an emergency laparotomy was performed, and it showed an omental pregnancy, confirmed at the pathological examination.

Successful laparoscopic management of primary omental pregnancy

Omental pregnancy is an extremely rare type of ectopic pregnancy. We present a case in which a 26-year-old woman was admitted to the emergency room with abdominal pain. She was diagnosed with a ruptured ectopic pregnancy after a positive urinary pregnancy test and transvaginal ultrasound. Laparoscopic surgery showed intact pelvic organs and an ectopic mass on the omentum. The patient was treated successfully with laparoscopic partial omentectomy, and pathologic examination confirmed an omental pregnancy. As evidenced by this case, laparoscopy can be useful to diagnose and treat unusually located ectopic pregnancies.

Laparoscopic management of a primary omental pregnancy after clomiphene induction

To describe the successful laparoscopic management of a primary omental pregnancy. Case report. Department of Obstetrics and Gynecology, Dr. Sami Ulus Obstetrics, Gynecology and Children's Hospital, Ankara, Turkey. A 22-year-old patient with an omental pregnancy. Laparoscopic partial omentectomy. Successful laparoscopic management of an omental pregnancy. A 22-year-old woman presented to the emergency room with abdominal pain and vaginal spotting. She was undergoing clomiphene (CC) induction for infertility and had a positive urine pregnancy test at home. A right adnexal ectopic pregnancy was reported by ultrasonography. Due to increasing pain, laparoscopy was performed. The uterus and fallopian tubes appeared normal without any signs of pregnancy. A well-vascularized intact omental gestational sac was discovered in the right adnexal region in close proximity to the right ovary. By laparoscopy, the sac was resected with partial omentectomy. A primary omental pregnancy was confirmed by beta-hCG-positive trophoblast cells among omental fat cells. Omental pregnancy is rather difficult to identify due to localization. When in close proximity to the adnexal region, it may mimic a tubal ectopic pregnancy. Laparoscopy offers a minimally invasive method for diagnosis and therapy.

Laparoscopic Management of Primary Omental Pregnancy

Abdominal pregnancy is a rare and serious type of extrauterine pregnancy that is estimated to be approximately 1% to 4% of all ectopic pregnancies with omental pregnancy is the least common. An incidental case of a primary omental pregnancy was treated by laparoscopic partial omentectomy. The aim of this presentation is to keep in mind that pregnancy can exist in unusual locations, so a thorough inspection of the abdominal cavity is imperative.

Primary omental pregnancy: case report and review of literature

Omental pregnancy is a very rare form of ectopic pregnancy. A 29-year-old woman presented with severe abdominal pain. History of the patient revealed use of combined oral contraceptive pills. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; gestational sac was detected attached to the necrotic lower edge of omentum. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexal involvement.

Laparoscopic management of early primary omental pregnancy

To describe the successful laparoscopic management of an omental pregnancy. Case report. University of Schleswig-Holstein, Campus Luebeck, Department of Gynecology and Obstetrics. A 25-year-old patient with an omental pregnancy. Laparoscopic partial omentectomy. Successful laparoscopic management of an omental pregnancy. A 25-year-old woman reported having abdominal pain. Her urine pregnancy test was positive. She had been using an intrauterine copper device for a period of 2.5 years. Gynecologic examination revealed normal results, in the uterus and fallopian tubes especially, where no signs of pregnancy were found through clinical and sonographic examination. Because the patient had had increasing pain, a laparoscopy was performed. There was approximately 500 mL of dark blood found in the cul de sac. The uterus and fallopian tubes appeared normal and without any signs of pregnancy. However, there was a cavity detected in the omentum majus. A partial omentectomy then was performed laparoscopically. An omental pregnancy was confirmed by beta-hCG-positive trophoblast cells in the omentum majus. Omental pregnancy can be rather difficult to identify. If there is no evidence of tubal pregnancy, laparoscopy may help to confirm the diagnosis of omental pregnancy and simultaneously offer minimal invasive therapy.

Primary Omental Pregnancy on the Gastrocolic Ligament

Omental pregnancy is an extremely rare form of abdominal pregnancy. Only 16 cases had been reported in the literature, and most were secondary omental pregnancies. We presented a case of primary omental pregnancy located on "gastrocolic ligament" diagnosed at surgical operation. The aim of this presentation is to remember that pregnancy can exist in unusual localizations, so abdominal observation and examination is very important during operations.

Primary omental pregnancy: Case report

Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman submitted with severe abdominal pain, without any delay of menstruation. History of the patient revealed no use of contraceptive method. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; omental pregnancy was detected and partial omentectomy was performed. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexial involvement.

Primary omental pregnancy treated by laparoscopic surgery

Abdominal pregnancy occurs in 1.4% of all ectopic pregnancy cases, and omental pregnancy is the least common form of abdominal pregnancies. The mortality rate for abdominal pregnancy is seven times higher than for non-abdominal ectopic pregnancy w1x. A review of the literature showed that only a few cases of omental pregnancies have been reported to date, and most were secondary omental pregnancies treated by laparotomic surgery. To support a diagnosis of primary abdominal pregnancy, histologic evidence of neovascularization or growth of trophoblast into the supporting tissue must be found w2x. This is the report of a case of a primary omental pregnancy treated by laparoscopic partial omentectomy. The patient, a 28-year-old woman in her 5th week of gestation, gravida 4, para 1, presented to the emergency room with lower abdominal pain accompanied by cold sweat and episodes of syncope. Physical examination was remarkable for the presence of diffuse abdominal tenderness. Her urine pregnancy test was positive and ultrasonographic exploration revealed internal bleeding and a complex mass in the right uterine adnexa. The

Laparoscopic Surgery for Omental Pregnancy

A 16-year-old girl underwent emergency laparoscopic surgery for what was thought to be hematoperitoneum secondary to extrauterine pregnancy. During the operation, omental pregnancy was diagnosed and treated by laparoscopy. According to Studiford's criterion, this case can be classified as a primary omental pregnancy. When performing laparoscopy for suspected tubal pregnancy with no visible pathologic changes on either tube, careful evaluation of the whole abdominal cavity is necessary so as not to overlook an abdominal pregnancy.

Primary omental pregnancy. 2 cases of primary peritoneal pregnancy.

From the Department of Obstetrics and Gynecology, The University of Rochester School of Medicine and Dentistry, Rochester, N. Y. Dr. A. Levay translated the German literature, and Dr. W. Van Huysen reviewed the pathologic material. Submitted for publication June 12, 1967.

Idiopathic hypercalcaemia in an infant; clinical and post-mortem findings in one case.

Omental pregnancy is a rare form of ectopic pregnancy, and can be seen primarily or secondary to a tubal pregnancy. A 25-year-old woman presented with abdominal distention with pain and anemia without vaginal bleeding. After a provisional diagnosis of ruptured ectopic pregnancy, laparotomy was performed. On surgical exploration, the bilateral tubes and ovaries were intact, however, an omental pregnancy was detected as the cause of hemoperitoneum. Partial omentectomy was performed. Although most cases are secondary, presented here is an additional case of primary omental pregnancy at 12 weeks according to Studdiford9s criteria. Histological evidence of neovascularization into the supporting tissue confirmed our diagnosis. A primary omental pregnancy should always be considered as a possible explanation for severe hemoperitoneum in ectopic pregnancies presenting with acute abdomen, and with intact adnexes on surgical exploration.