title: Laparoscopic Management of an Invasive Mole Perforating the Uterus.
abstract: To show the possibility of conservative laparoscopic management in a case of invasive mole perforating the uterus.
  
  
  
  Video with explanations.
  
  
  
  An invasive mole is a potentially life-threatening complication of gestational trophoblastic disease [1]. This is a case of a 24-year-old female presenting with abdominal pain and vaginal bleeding. There have been several previous reports of cases of uterine perforation by an invasive mole, all of which were managed with abdominal hysterectomy [2-7]. To our knowledge, this is the first report of an invasive mole perforation with active bleeding managed by laparoscopy without hysterectomy.
  
  
  
  Sonography revealed a large amount of fluid and a 3 × 3-cm heterogeneous lesion next to the posterior uterine wall. Her hemoglobin level dropped from 10.6 mg/dL to 8.6 mg/dL, and her β-human chorionic gonadotropin level was 19,004 mIU/mL. On laparoscopy, ∼2500 mL of hemoperitoneum was found, along with an actively bleeding bulging mass in the posterior uterine wall. This mass was dissected, and hemostasis was secured with sutures and electrocoagulation. Pathology confirmed the diagnosis of a complete mole. After surgery, the patient was treated with 5 courses of a methotrexate-folinic acid regimen. Her recovery was uneventful.
  
  
  
  Uterine perforation by an invasive mole can be managed conservatively with laparoscopic surgery and postoperative chemotherapy. The transmural lesion will increase the risk of future uterine rupture during pregnancy in this patient.
authors.affiliation: Department of Obstetrics and Gynecology, Barziali Medical Center, Ben-Gurion University, Ashkelon, Israel. Electronic address: Leonti.grin@gmail.com.
authors.forename: Leonti
authors.initials: L
authors.lastname: Grin
authors.affiliation: Department of Obstetrics and Gynecology, Barziali Medical Center, Ben-Gurion University, Ashkelon, Israel.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Namazov
authors.affiliation: Department of Obstetrics and Gynecology, Barziali Medical Center, Ben-Gurion University, Ashkelon, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Volodarsky
authors.affiliation: Department of Obstetrics and Gynecology, Barziali Medical Center, Ben-Gurion University, Ashkelon, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Anteby
authors.affiliation: Department of Obstetrics and Gynecology, Barziali Medical Center, Ben-Gurion University, Ashkelon, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Lavie
authors.affiliation: Department of Obstetrics and Gynecology, Barziali Medical Center, Ben-Gurion University, Ashkelon, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Gemer
mesh_terms: D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006465:Hemoperitoneum / Q000209:etiology / Q000601:surgery; D006801:Humans; D002820:Hydatidiform Mole, Invasive / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery; D014594:Uterine Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014597:Uterine Rupture / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate
keywords: Invasive mole; Laparoscopy; Uterine rupture