Rare Presentation of Chorioadenoma Destruens as Acute Haemoperitoneum Mimicking Ruptured Ectopic Pregnancy.
Gestational trophoblastic neoplasms (GTN) are proliferative degenerative disorders of placental elements and include complete or partial mole (90%), invasivemole (5-8%), choriocarcinoma (1-2%) and placental site tumor (1-2%). Chorioadenoma destruens is a trophoblastic tumor, characterized by myometrial invasion through direct extension or via venous channels. We present a case of invasive mole eroding uterus and uterine vasculature, causing sudden rupture of uterus with massive haemoperitoneum mimicking ectopic pregnancy. A 20 year old G1P0 at 6 weeks gestation presented in Casualty of Kasturba Hospital complaining of severe acute onset lower abdominal pain for one hour. Clinical examination revealed shock. Sonography suggested ectopic pregnancy and immediate exploratory laparotomy was decided. On laparotomy, 2000cc of haemoperitoneum was noted. Grape like vesicles protruding through fundal perforation with profuse active bleeding was seen. Bleeding persisted despite evacuation. Step wise uterine devascularisation failed to achieve haemostasis. Total abdominal hysterectomy was performed as a life saving measure.
Department of Obstetrics & Gynaecology Kasturba Hospital, Delhi, India.
M
M
Sinha
Department of Obstetrics & Gynaecology Kasturba Hospital, Delhi, India.
R
R
Kaur
West Virginia University- Charleston Division Charleston Area Medical Center Charleston, West Virginia, USA.
R
R
Gupta
Department of Obstetrics & Gynaecology Kasturba Hospital, Delhi, India.
R
R
Rani
Department of Obstetrics & Gynaecology Kasturba Hospital, Delhi, India.
A
A
Aggarwal
D000328:Adult; D005260:Female; D006465:Hemoperitoneum / Q000473:pathology*; D006801:Humans; D002820:Hydatidiform Mole, Invasive / Q000175:diagnosis* / Q000473:pathology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis; D012422:Rupture, Spontaneous / Q000209:etiology* / Q000473:pathology; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology