Omental trophoblastic implants and hemoperitoneum after laparoscopic salpingostomy for ectopic pregnancy. A case report.
BACKGROUND
In this era of cost containment, laparoscopic management of ectopic pregnancy has become the mainstay of dealing with this common gynecologic emergency. The aim of surgical intervention remains conservation of the fallopian tube, if possible; salpingectomy is reserved for cases of tubal rupture and/or recurrent ectopic pregnancy, where little hope exists of salvaging tubal function.


METHODS
A 28-year-old woman, para 2, underwent laparoscopic salpingostomy for ectopic pregnancy. She experienced intraabdominal bleeding within the initial 12 hours of the postoperative period. On exploratory laparotomy, there was active bleeding from the site of the salpingostomy, and a salpingectomy was performed. The patient was lost to follow-up and on postoperative day 21 presented with signs of intraabdominal bleeding; repeat laparotomy revealed active bleeding from trophoblastic implants within the greater omentum. The omentum was adherent to the anterior abdominal wall at the site of umbilical trocar placement. An infracolic omentectomy was performed, with a subsequent uneventful postoperative course; the patient was followed until resolution of the serum beta-hCG.


CONCLUSIONS
Postoperative surveillance is important. Positive intraabdominal pressure during laparoscopic surgery and the Trendelenburg position may be contributory to cephalad migration of trophoblast remnants, with the scavenging action of the omentum and adherence to the site of umbilical trocar placement theoretically providing a mechanism for neovascularization and sustenance of the parasitic trophoblast.
Pal
Lubna
L
Departments of Gynecology and Pathology, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA. lubnapal@hotmail.com
Parkash
Vinita
V
Rutherford
Thomas J
TJ
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006465:Hemoperitoneum / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007813:Laparotomy; D009852:Omentum / Q000473:pathology; D010532:Peritoneal Diseases / Q000209:etiology* / Q000601:surgery*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000000981:diagnostic imaging / Q000601:surgery*; D018570:Risk Assessment; D012489:Salpingostomy / Q000009:adverse effects* / Q000379:methods; D014327:Trophoblasts / Q000473:pathology*; D016216:Ultrasonography, Prenatal