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Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Ectopic Pregnancy | Case report

Successful laparoscopic management of diaphragmatic pregnancy:a rare case report and brief review of literature

Authors: Lifeng Chen, Jinwei Liu, Jing Shu, Wenjie Zeng, Xiaofeng Zhao

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

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Abstract

Background

Abdominal ectopic pregnancies are rare category of ectopic pregnancies.We describe a ectopic pregnancy implanted on the surface of diaphragm and highlight the difficult clinical course of an abdominal ectopic pregnancy managed with strategic procedural intervention.

Case presentation

A 33-year-old Chinese woman with abdominal pain was diagnosed with ectopic pregnancy implanted in the liver according to CT and advised to transfer the patient to tertiary referral center. The patient had a significant increasing abdominal pain and intense reflex sensitivity in the right shoulder when she presented to our hospital. Laparoscopic surgery was decided immediately with the impression of ruptured abdominal pregnancy and hemorrhagic shock. It was found that ectopic pregnancy was implanted on the diaphragmatic surface.The pregnant tissue was completely resected from the diaphragm and bipolar electrocoagulation was used to control bleeding. The patient was stable and discharged 3 days after surgery in a good condition.

Conclusion

CT or MRI should be considered as an alternative to TVS in the management of ectopic pregnancy patients with unusual presentations. A thorough observation of the entire pelvis and upper abdomen during laparoscopic exploration is crucial for diagnosis.
Literature
1.
go back to reference Shen L, Fu J, Huang W, Zhu H, Wang Q, Yang S, Wu T. Interventions for non-tubal ectopic pregnancy. Cochrane data-base of. Systematic Reviews. 2014;7:CD011174. Shen L, Fu J, Huang W, Zhu H, Wang Q, Yang S, Wu T. Interventions for non-tubal ectopic pregnancy. Cochrane data-base of. Systematic Reviews. 2014;7:CD011174.
2.
go back to reference Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009;23(4):529–38.CrossRef Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009;23(4):529–38.CrossRef
3.
go back to reference Dover RW, Powell MC. Management of a primary abdominal pregnancy. Am J Obstet Gynecol. 1995;172(5):1603–4.CrossRef Dover RW, Powell MC. Management of a primary abdominal pregnancy. Am J Obstet Gynecol. 1995;172(5):1603–4.CrossRef
4.
go back to reference Agarwal N, Odejinmi F. Early abdominal ectopic pregnancy: challenges, update and review of current management. The Obstetrician & Gynaecologist. 2014;16:193–8.CrossRef Agarwal N, Odejinmi F. Early abdominal ectopic pregnancy: challenges, update and review of current management. The Obstetrician & Gynaecologist. 2014;16:193–8.CrossRef
5.
go back to reference Al-Memar M, Kirk E, Bourne T. The role of ultrasonography in the diagnosis and management of early pregnancy complications. Obstet Gynaecol. 2005;17(3):173–81. Al-Memar M, Kirk E, Bourne T. The role of ultrasonography in the diagnosis and management of early pregnancy complications. Obstet Gynaecol. 2005;17(3):173–81.
6.
go back to reference Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250–61.CrossRef Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250–61.CrossRef
7.
go back to reference Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. The diagnosis and treatment of ectopic pregnancy. Dtsch Arztebl Int. 2015;112(41):693–703.PubMedPubMedCentral Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. The diagnosis and treatment of ectopic pregnancy. Dtsch Arztebl Int. 2015;112(41):693–703.PubMedPubMedCentral
8.
go back to reference Tong S, Skubisz MM, Horne AW. Molecular diagnostics and therapeutics for ectopic pregnancy. Mol Hum Reprod. 2015;21(2):126–35.CrossRef Tong S, Skubisz MM, Horne AW. Molecular diagnostics and therapeutics for ectopic pregnancy. Mol Hum Reprod. 2015;21(2):126–35.CrossRef
9.
go back to reference Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol. 2012;206(4):289–99.CrossRef Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol. 2012;206(4):289–99.CrossRef
10.
go back to reference Studdiford W. Primary peritoneal pregnancy. American Journal of Obstetrics & Gynecology. 1942;44:487–91.CrossRef Studdiford W. Primary peritoneal pregnancy. American Journal of Obstetrics & Gynecology. 1942;44:487–91.CrossRef
11.
go back to reference Friedrich EG Jr, Rankin CA. Jr primary pelvic peritoneal pregnancy. Obstet Gynecol. 1968;31(5):649–53.CrossRef Friedrich EG Jr, Rankin CA. Jr primary pelvic peritoneal pregnancy. Obstet Gynecol. 1968;31(5):649–53.CrossRef
12.
go back to reference Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011;37(4):231–40.CrossRef Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011;37(4):231–40.CrossRef
13.
go back to reference Condous G, Timmerman D, Goldstein S, Valentin L, Jurkovic D, Bourne T. Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol. 2006;28(2):121–2.CrossRef Condous G, Timmerman D, Goldstein S, Valentin L, Jurkovic D, Bourne T. Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol. 2006;28(2):121–2.CrossRef
14.
go back to reference Yagil Y, Beck-Razi N, Amit A, Kerner H, Gaitini D. Splenic pregnancy: the role of abdominal imaging. J Ultrasound Med. 2007;26(11):1629–32.CrossRef Yagil Y, Beck-Razi N, Amit A, Kerner H, Gaitini D. Splenic pregnancy: the role of abdominal imaging. J Ultrasound Med. 2007;26(11):1629–32.CrossRef
15.
go back to reference Gang G, Yudong Y, Zhang G. Successful laparoscopic management of early splenic pregnancy: case report and review of literature. J Minim Invasive Gynecol. 2010;17(6):794–7.CrossRef Gang G, Yudong Y, Zhang G. Successful laparoscopic management of early splenic pregnancy: case report and review of literature. J Minim Invasive Gynecol. 2010;17(6):794–7.CrossRef
16.
go back to reference Wong E, Suat SO. Ectopic pregnancy--a diagnostic challenge in the emergency department. Eur J Emerg Med. 2000;7(3):189–94.CrossRef Wong E, Suat SO. Ectopic pregnancy--a diagnostic challenge in the emergency department. Eur J Emerg Med. 2000;7(3):189–94.CrossRef
17.
go back to reference Daniilidis A, Pantelis A, Makris V, Balaouras D, Vrachnis N. A unique case of ruptured ectopic pregnancy in a patient with negative preg-nancy test - a case report and brief review of the literature. Hippokratia. 2014;18(3):282–4.PubMedPubMedCentral Daniilidis A, Pantelis A, Makris V, Balaouras D, Vrachnis N. A unique case of ruptured ectopic pregnancy in a patient with negative preg-nancy test - a case report and brief review of the literature. Hippokratia. 2014;18(3):282–4.PubMedPubMedCentral
18.
go back to reference Julania S, Tai R. Heterotopic simultaneous splenic and intrauterine pregnancy after spontaneous conception and review of literature. J Obstet Gynaecol Res. 2013;39(1):367–70.CrossRef Julania S, Tai R. Heterotopic simultaneous splenic and intrauterine pregnancy after spontaneous conception and review of literature. J Obstet Gynaecol Res. 2013;39(1):367–70.CrossRef
19.
go back to reference Poole A, Haas D, Magann EF. Early abdominal ectopic pregnancies: a systematic review of the literature. Gynecol Obstet Investig. 2012;74(4):249–60.CrossRef Poole A, Haas D, Magann EF. Early abdominal ectopic pregnancies: a systematic review of the literature. Gynecol Obstet Investig. 2012;74(4):249–60.CrossRef
20.
go back to reference Andres MP, Campillos JM, Lapresta M, Lahoz I, Crespo R, Tobajas J. Management of ectopic pregnancies with poor prognosis through ultrasound guided intrasacular injection of methotrexate, series of 14 cases. Arch Gynecol Obstet. 2012;285(2):529–33.CrossRef Andres MP, Campillos JM, Lapresta M, Lahoz I, Crespo R, Tobajas J. Management of ectopic pregnancies with poor prognosis through ultrasound guided intrasacular injection of methotrexate, series of 14 cases. Arch Gynecol Obstet. 2012;285(2):529–33.CrossRef
21.
go back to reference Monteagudo A, Minior VK, Stephenson C, Monda S, Timor-Tritsch IE. Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series. Ultrasound Obstet Gynecol. 2005;25(3):282–8.CrossRef Monteagudo A, Minior VK, Stephenson C, Monda S, Timor-Tritsch IE. Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series. Ultrasound Obstet Gynecol. 2005;25(3):282–8.CrossRef
22.
go back to reference Python JL, Wakefield BW, Kondo KL, Bang TJ, Stamm ER, Hurt KJ. Ultrasound-guided percutaneous Management of Splenic Ectopic Pregnancy. J Minim Invasive Gynecol. 2016;23(6):997–1002.CrossRef Python JL, Wakefield BW, Kondo KL, Bang TJ, Stamm ER, Hurt KJ. Ultrasound-guided percutaneous Management of Splenic Ectopic Pregnancy. J Minim Invasive Gynecol. 2016;23(6):997–1002.CrossRef
23.
go back to reference Odejinmi F, Sangrithi M, Olowu O. Operative laparoscopy as the mainstay method in management of hemodynamically unstable patients with ectopic pregnancy. J Minim Invasive Gynecol. 2011;18(2):179–83.CrossRef Odejinmi F, Sangrithi M, Olowu O. Operative laparoscopy as the mainstay method in management of hemodynamically unstable patients with ectopic pregnancy. J Minim Invasive Gynecol. 2011;18(2):179–83.CrossRef
24.
go back to reference Gupta P, Sehgal A, Huria A, Mehra R. Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports. J Med Case Rep. 2009;3:7382.CrossRef Gupta P, Sehgal A, Huria A, Mehra R. Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports. J Med Case Rep. 2009;3:7382.CrossRef
Metadata
Title
Successful laparoscopic management of diaphragmatic pregnancy:a rare case report and brief review of literature
Authors
Lifeng Chen
Jinwei Liu
Jing Shu
Wenjie Zeng
Xiaofeng Zhao
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2248-0

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