| Author: Eva Račanská
Description:
30 year old 6 gravida 0 para arrives for the strong pelvic pain which started 5 days ago. 1 day before the pain onset, she underwent dilation & curretage performed by her gynecologist for the spontaneus abortion (she had pregnancy test positive but vaginal bleeding started and there was no gestation sac seen in the uterine cavity). Patients is followed for infertility, she had 5 spontaneus abortions at the 1st trimester of pregnancy and 1 missed abortion at 21 wks of pregnancy which was caused by umbilical cord strangulation according to the autopsy report. No known abnormalities in her or partner's karyotype.
She had 7 wks amenorrhoea at the time of admition to the hospital. Bimanual pelvic examination showed nor abnormalities except of tenderness in the right adnexal region. Ultrasound examination described anteverted uterus with transmural leiomyoma 25 mm in diameter in the uterine fundus, endometrium of 4 mm, both ovaries of normal size and large amount of echogenic mass - blood coagula behind the uterus. Diagnosis of possible uterine perforation during the previous D&C was built. Diagnostic laparoscopy was performed. There were old blood coagula and approximately 150 ml of blood in the pelvic cavity. Uterus was intact with no sign of perforation with a promimence of the leiomyoma from the posterior uterine wall. Left ovary and left uterine tube were of normal size, shape with no abnormalities. Right ovary adhered to the right uterine tube which was dilated, livid with a perforation and fillied with tubal pregnancy. Right salpingectomy had to be performed due to the uterine tube destruction. Histology report confirmed tubal pregnancy of the right uterine tube with immature placental villi.
Categorization:
Tubal pregnancy
Attachments:
Description: Uterus and coagulated blood.
Description: Coagulated blood around uterine tube which is livid and dilated with tubal pregnancy.
Description: Blood in the pouch of Douglas.
Description: Uterus and right uterine horn after removal of the right uterine tube.