Accepted Manuscript

Laparoscopic removal of an abdominal pregnancy in the pelvic

sidewall

Oshri Barel MD, MHA, FRANZCOG , Ramy Rahamim Suday MD ,

Jonathan Stanleigh MD , Mordechai Pansky MD

PII: S1553-4650(19)30006-8
DOI: https://doi.org/10.1016/j.jmig.2018.12.020
Reference: JMIG 3724

To appear in: The Journal of Minimally Invasive Gynecology

Received date: 17 December 2018

Accepted date: 26 December 2018

Please cite this article as: Oshri Barel MD, MHA, FRANZCOG , Ramy Rahamim Suday MD ,
Jonathan Stanleigh MD , Mordechai Pansky MD , Laparoscopic removal of an abdominal preg-
nancy in the pelvic sidewall, The Journal of Minimally Invasive Gynecology (2019), doi:
https://doi.org/10.1016/j.jmig.2018.12.020

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 ACCEPTED MANUSCRIPT
––Laparoscopic removal of an abdominal pregnancy in the pelvic sidewall

Authors:

Barel Oshri MD, MHA, FRANZCOG department of Obstetrics and Gynecology. Assuta Ashdod
University Hospital. Ashdod, Israel. Affiliated with the faculty of Health Sciences. Ben Gurion
University. barelod@gmail.com.
Suday Ramy Rahamim, MD Department of Obstetrics and Gynecology. Assuta Ashdod University
Hospital. Ashdod, Israel. suday.ramy@gmail.com
Stanleigh Jonathan MD, Department of Obstetrics and Gynecology. Assuta Ashdod University
Hospital. Ashdod, Israel. jonathans@assuta.co.il
Pansky Mordechai MD, Department of Obstetrics and Gynecology. Assuta Ashdod University
Hospital. Ashdod, Israel. mordechaipa@assuta.co.il

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All authors of this article did not report any potential conflict of interest
––Laparoscopic removal of an abdominal pregnancy in the pelvic sidewall

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Objective: To present the presentation, diagnosis and management of a patient with abdominal pregnancy and

to illustrate the laparoscopic technique in which management was preformed

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Design: A descriptive study (Canadian task force level III) approved by our local institutional review board.

Consent was given from the patient.

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Setting: A university hospital in Ashdod, Israel
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Patient: On May 15th 2018, a Gravida-3 Para-2, 37-year-old asymptomatic patient was referred to the

gynecological emergency department due to a suspected ectopic pregnancy. The patient had no relevant
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medical or surgical history. Her obstetric history consisted of two spontaneous vaginal deliveries and no other

significant gynecological history. Her menses were regular, every month. Her Last menstrual period was six
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weeks prior to presentation. βHCG a day prior to presentation was 24,856IU/L. Physical examination was

unremarkable except for a small amount of brownish vaginal discharge. A transvaginal ultrasound (TVUS)
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exam on presentation did not demonstrate an intra-uterine gestational sac, the examination revealed a
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gestational sac and a fetus next to the right adnexa, with a crown-rump length of 1.3cm, consistent with 7+3

gestational weeks. There was a minimal amount of fluid in the Pouch of Douglas.

Intervention: Due to an extra-uterine pregnancy with high βHCG values, laparoscopic operative management

was chosen. Upon entrance to the abdominal cavity, a normal uterus and two ovaries and fallopian tubes were

observed. A small to moderate amount of blood was present in the pouch of Douglas. Over the right

uterosacral ligament, a three to four centimeter distension was noticed. Following delicate probing of the area

moderate to severe bleeding commenced, this was initially controlled with local pressure and a oxidized

regenerated cellulose (Surgicell®). An intra-operative TVUS identified an abdominal pregnancy in the right
 ACCEPTED MANUSCRIPT
pelvic sidewall. The gestational sac was completely dissected and removed following uretrolysis and

separation of the right ureter from the specimen. Local injection of vasopressin was also used. βHCG before

surgery was 19,008IU/L, at post-operative day 1 the value decreased to 6339IU/L. Patient was discharged in

good condition at the 2nd post-operative day. A final histopathologic report confirmed a gestational sac.

Measurement and main results: A patient referred for a tubal ectopic pregnancy was eventually diagnosed

with an abdominal pregnancy and was treated operatively with a complete excision of the abdominal

pregnancy, which was located at the right pelvic sidewall.

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Conclusion: An abdominal pregnancy is a rare kind of ectopic pregnancy with a reported incidence of

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1:10,000 – 1:30,000 pregnancies, and about 1% of ectopic pregnancies. It carries a high risk for maternal

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morbidity and mortality. Many different locations at different gestational ages have been reported in the

literature including in the Pouch of Douglas; pelvic sidewall; bowel; broad ligament; omentum and spleen.

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Combined with the rarity of this type of pregnancy its diagnosis is challenging and treatment not uniform. The

location of the growing fetal tissue may endanger the patient’s life as it could be close to vital anatomic
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structures. In our case, a gestational sac was very close to the right ureter. In this case, we opted to surgically

excise the gestational sac in its entirety.

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Keywords: Abdominal pregnancy; Laparoscopy; Ectopic pregnancy

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