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Table of Contents
VIDEO ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 270-271

Endometriotic peritoneal defect is a risk factor for peritoneal ectopic pregnancy or tubal abortion implant


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 Submission28-Nov-2020
Date of Decision01-Feb-2021
Date of Acceptance26-Apr-2021
Date of Web Publication5-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
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_123_20

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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 Top


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 Top


Both of this 2 cases post-remission laparoscopic is without adjuvant therapy.


  Conclusion Top


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 Top

1.
Lee JW, Sohn KM, Jung HS. Retroperitoneal ectopic pregnancy. AJR Am J Roentgenol 2005;184:1600-1.  Back to cited text no. 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.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    
5.
Okorie CO. Retroperitoneal ectopic pregnancy: is there any place for non-surgical treatment with methotrexate? J Obstet Gynaecol Res 2010;36:1133-6.  Back to cited text no. 5
    
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.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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