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| VIDEO ARTICLE |
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| Year : 2021 | Volume
: 10
| Issue : 4 | Page : 270-271 |
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Endometriotic peritoneal defect is a risk factor for peritoneal ectopic pregnancy or tubal abortion implant
Lee Koon Kwek1, Yang Huang Grace Ng2, Shahul Hameed Mohamed Siraj3, Yen Ching Yeo4
1 Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
2 Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
3 Department of Minimally Invasive Surgery, KK Women's and Children's Hospital, Singapore
4 Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| Date of Submission | 28-Nov-2020 |
| Date of Decision | 01-Feb-2021 |
| Date of Acceptance | 26-Apr-2021 |
| Date of Web Publication | 5-Nov-2021 |
Correspondence Address:
Dr. Lee Koon Kwek
Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899
Singapore
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/GMIT.GMIT_123_20
How to cite this article:
Kwek LK, Grace Ng YH, Siraj SH, Yeo YC. Endometriotic peritoneal defect is a risk factor for peritoneal ectopic pregnancy or tubal abortion implant. Gynecol Minim Invasive Ther 2021;10:270-1 |
How to cite this URL:
Kwek LK, Grace Ng YH, Siraj SH, Yeo YC. Endometriotic peritoneal defect is a risk factor for peritoneal ectopic pregnancy or tubal abortion implant. Gynecol Minim Invasive Ther [serial online] 2021 [cited 2021 Dec 3];10:270-1. Available from: https://www.e-gmit.com/text.asp?2021/10/4/270/329862 |
| Objective | |  |
Demonstrate retroperitoneal ectopic pregnancy (REP)[1],[2] occurs when implantation happens in the retroperitoneal space.
Design
Laparoscopic treatment in case 1.
Laparoscopic treat with MTX adjuvant treatment.
Patients
The first case presented with abdominal pain and high serum beta-human chorionic gonadotrophin (BhCG). Laparoscopy showed a bleeding peritoneal defect which was excised and serum BhCG normalized thereafter [Figure 1]. | Figure 1: (a) Pelvic ultrasonography of left adnexal mass with a 1.7 cm × 1.0 cm × 1.6 cm cystic focus and thick echogenic rim. (b) Intraoperative photograph of retroperitoneal ectopic pregnancy lateral to the left uterosacral ligament. (c) Histopathology images (from left to right). (i) Crushed fibrofatty tissue with endometrial gland and surrounding stroma in keeping with endometrioisis. (ii) Collections of trophoblastic cells admixed with blood and fibrin. (iii) Immunohistochemistry for GATA 3 highlights the trophoblastic cells
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The second case presented similarly. Laparoscopy was negative but follow up BhCG continued rising. Evacuation of the uterus was done with no products of conception seen. Intramuscular methotrexate was given twice with declining BhCG. However, patient presented with pain requiring laparoscopy. Intraoperatively, an ectopic pregnancy implanted in the peritoneal defect was removed and serum BhCG dropped thereafter [Figure 2]. | Figure 2: Ultrasound and intraoperative image of Case 2. Retrospective review of intraoperative image from first diagnostic laparoscopy (Right below)
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Interventions
Laparoscopy showed oozing from a peritoneum defect lateral to left uterosacral ligament which was excised. After laparoscopy was negative medical treat was give with Intramuscular methotrexate (IM MTX).
| Results | | |
Both of this 2 cases post-remission laparoscopic is without adjuvant therapy.
| Conclusion | | |
Peritoneal survey during negative laparoscopy in common endometriotic sites is critical, especially in the presence of endometriotic peritoneal defects.[3],[4] Surgical excision allows for histology, but risks damage to adjacent organs. Alternatives include local or systemic MTX,[5],[6] (Case 2) or conservative management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Supplementary material
Supplementary material associated with this article be found in the online version at http://www.apagemit.com/page/video/show.aspx?num=263&page=1.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Lee JW, Sohn KM, Jung HS. Retroperitoneal ectopic pregnancy. AJR Am J Roentgenol 2005;184:1600-1.  |
| 2. | Yang Y, Liu Z, Song L, Liu H, Li L, Meng Y. Diagnosis and surgical therapy of the retroperitoneal ectopic pregnancy: A case report. Int J Surg Case Rep 2018;49:21-4. |
| 3. | Yabushita H, Shimazu M, Yamada H, Sawaguchi K, Noguchi M, Nakanishi M, et al. Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer. Gynecol Oncol 2001;80:139-44. |
| 4. | Sampson JA. Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am J Pathol. 1927;3:93-110.143. |
| 5. | Okorie CO. Retroperitoneal ectopic pregnancy: is there any place for non-surgical treatment with methotrexate? J Obstet Gynaecol Res 2010;36:1133-6. |
| 6. | Iwama H, Tsutsumi S, Igarashi H, Takahashi K, Nakahara K, Kurachi H. A case of retroperitoneal ectopic pregnancy following IVF-ET in a patient with previous bilateral salpingectomy. Am J Perinatol 2008;25:33-6. |
[Figure 1], [Figure 2]
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