Single Incision Laparoscopic management of a ruptured Heterotopic pregnancy presenting as an acute appendicitis: A case report

Main Article Content

ross downes

Abstract

Heterotopic pregnancy, defined as the coexistence of an intrauterine pregnancy and an extrauterine pregnancy.  It is a rare entity and theoretically occurs at an incidence of 1 in 30 000 pregnancies (2,3,12). The rise in the incidence of tubal and pelvic diseases has contributed to an increasing rate of heterotopic pregnancies. This rise can also be attributed to the increasing use of assisted reproductive technology such as In Vitro Fertilization (IVF) and Gamete intra-fallopian transfer (GIFT) (2,3,11,12).  After assisted reproductive technology procedures, the incidence of heterotopic pregnancy is at a concerning 1 in 100 pregnancies (2,12).

The treatment of heterotopic pregnancy aims to maintain the intrauterine pregnancy while removing the extrauterine pregnancy using a minimally invasive method (1). The treatment modalities for heterotopic pregnancy can be divided into surgical and non-surgical treatments. Non-surgical treatments involve the direct administration of drugs, such as potassium chloride, methotrexate, and hyperosmolar glucose to the extrauterine gestational sac under ultrasonographic or laparoscopic guidance (10,11).  Systemic management of these agents is difficult because these treatments can result in termination of both the desirable intrauterine and unwanted extrauterine pregnancy (7).  Surgical management, particularly laparoscopic surgery, has a shorter operating time, faster recovery, and less postoperative pain compared with those of laparotomy.

As seen in our patient, heterotopic pregnancy is a difficult entity to diagnose, often leading to the late detection of an extrauterine sac (2).  Our patient is a 36-year-old who has been trying to get pregnant for 2 years.  Because of the information available a diagnosis of acute appendicitis in pregnancy was made. There were no clear signs of a ruptured ectopic pregnancy despite ultrasonography been done. An emergency laparoscopic procedure was done highlighting the underlining pathology.

Article Details

How to Cite
DOWNES, ross. Single Incision Laparoscopic management of a ruptured Heterotopic pregnancy presenting as an acute appendicitis: A case report. Medical Research Archives, [S.l.], n. 3, may 2015. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/107>. Date accessed: 29 mar. 2024.
Keywords
Laparoscopy, single incision, single port, appendectomy, Heterotopic, ectopic,
Section
Case Reports

References

1. Eom J, Choi J, Hur C, et al. Surgical and obstetric outcomes of laparoscopic management for women with heterotopic pregnancy. The Journal Of Obstetrics And Gynaecology Research [serial online]. December 2013; 39(12):1580-1586.

2. Kirk E , Daemen A , Papageorghiou AT et al . Why are some ectopic pregnancies characterized as pregnancies of unknown location at the initial transvaginal ultrasound examination? Acta Obstetricia et Gynecologica Scandinavica 2008; 87 : 1150 – 1154 .

3. Ikechukwu, E., & Adeleni, M. Heterotopic pregnancy with live infant. Annals Of African Medicine, 2013;12(1), 43-45. doi:10.4103/1596-3519.108251

4. Nyberg DA, Mack LA, Jeffrey RB Jr, Laing FC. Endovaginal sonographic evaluation of ectopic pregnancy: a prospective study. AJR Am J Roentgenol 1987; 149:1181.

5. Dogra V, Paspulati RM, Bhatt S. First trimester bleeding evaluation. Ultrasound Q 2005; 21:69.

6. Casanova BC, Sammel MD, Chittams J, et al. Prediction of outcome in women with symptomatic first-trimester pregnancy: focus on intrauterine rather than ectopic gestation. J Womens Health (Larchmt) 2009; 18:195.

7. Louis-Sylvestre C, Morice P, Chapron C, Dubuisson JB. The role of laparoscopy in the diagnosis and management of heterotopic pregnancies. Hum Reprod 1997; 12:1100.

8. Barrenetxea G , Barinaga-Rementeria L , Lopez de Larruzea A et al . Heterotopic pregnancy: two cases and a comparative review. Fertility and Sterility 2007; 87: 417.e9 – e15 .
9. Goldstein JS, Ratts VS, Philpott T, Dahan MH. Risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy. Obstet Gynecol 2006; 107:506.

10. Goldberg JM, Bedaiwy MA. Transvaginal local injection of hyperosmolar glucose for the treatment of heterotopic pregnancies. Obstet Gynecol 2006; 107:509.

11. Salomon LJ, Fernandez H, Chauveaud A, et al. Successful management of a heterotopic Caesarean scar pregnancy: potassium chloride injection with preservation of the intrauterine gestation: case report. Hum Reprod 2003; 18:189.

12. Talbot K , Simpson R , Price N et al . Heterotopic pregnancy review. Journal of Obstetrics and Gynaecology 2011;31 : 7 – 12 .

13. Park HR, Moon MJ, Ahn EH (2009) Heterotopic quadruplet pregnancy: conservative management with ultrasonographically-guided KCl injection of cornual pregnancy and laparoscopic operation of tubal pregnancy. Fetal Diagn Ther 26:227–230

14. Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 2003

15. Sages. Guidelines for Diagnosis, Treatment, and Use of Laparoscopy for Surgical Problems during Pregnancy 2011