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Successful laparoscopic management of ruptured tubal pregnancy with an ipsilateral ectopic pelvic kidney.

Belotte J, Belotte J, Alexis M, Awonuga AO, Aguin TJ - Case Rep Obstet Gynecol (2014)

Bottom Line: Result.Conclusion.Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, C. S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Wayne State University, 275 E. Hancock, Detroit, MI 48201, USA.

ABSTRACT
Objective. To report a case of successful laparoscopic management of a left ruptured tubal pregnancy in the setting of an ipsilateral ectopic pelvic kidney. Method. Case report was prepared at Wayne State University/Detroit Medical Center. The patient is a young woman gravida 2 para 0 in her twenties who presented with severe abdominal pain and vaginal bleeding. She had a plateaued beta HCG and ultrasonographic findings suggestive of ectopic left tubal pregnancy along with an ectopic ipsilateral pelvic kidney. The IRB approval is not needed, as this is a case report. The informed consent could not be obtained, as the patient was not reachable. Result. Multiple intraperitoneal adhesions, left ruptured ampullary ectopic pregnancy and left retroperitoneal pelvic mass consistent with ipsilateral ectopic pelvic kidney. Conclusion. Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney.

No MeSH data available.


Related in: MedlinePlus

(a) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (b) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (c) Longitudinal view: ectopically located pelvic kidney with color Doppler (single arrow). (d) Transverse view: hypoechoic cystic structure with vascular flow in the left adnexa depicting a tubal pregnancy (single arrow).
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fig1: (a) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (b) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (c) Longitudinal view: ectopically located pelvic kidney with color Doppler (single arrow). (d) Transverse view: hypoechoic cystic structure with vascular flow in the left adnexa depicting a tubal pregnancy (single arrow).

Mentions: A woman G2P0010 in her twenties presented to the emergency room (ER) with a two-day history of nausea and vomiting, severe abdominal pain, vaginal spotting, and a missed menstrual period. Her symptoms began with vaginal spotting two days earlier and were followed with abdominal pain. She reported that the abdominal pain has improved from 10 out of 10 to 2 out of 10 in severity on the visual analog pain scale within the last 24 hours. Besides being diagnosed and adequately treated for genital chlamydia infection in 2006, her past histories are unremarkable. She is a social drinker, smoked cigarettes at a frequency of one pack per day for the last 5 years and also smoked marijuana. On physical examination, she was in no apparent distress with normal vital signs. A mild tenderness to palpation was elicited in the lower abdomen without rebound. Pelvic examination demonstrated a normal 6-week size anteverted but nontender uterus and mild-to-moderately tender left adnexa. The complete blood count was normal. She had a positive urine pregnancy test and a quantitative beta HCG of 1243 mIU/mL. A transvaginal ultrasonography (TVS) showed an empty uterus, a small amount of free fluid in the cul-de-sac, and an incidental left pelvic kidney (Figures 1(a), 1(b), and 1(c)). The patient was deemed stable with minimal pain and therefore was discharged home with instructions to follow up within 48 hours. Thirty-six hours later, she presented to our Institution with similar symptoms. At that time, the beta HCG increased 2673 mIU/mL and a repeat TVS revealed the hitherto diagnosed pelvic kidney, a 3-4 cm mass (Figure 1(d)) in the left adnexa, and an empty uterus with small amount of free fluid in the pelvis.


Successful laparoscopic management of ruptured tubal pregnancy with an ipsilateral ectopic pelvic kidney.

Belotte J, Belotte J, Alexis M, Awonuga AO, Aguin TJ - Case Rep Obstet Gynecol (2014)

(a) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (b) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (c) Longitudinal view: ectopically located pelvic kidney with color Doppler (single arrow). (d) Transverse view: hypoechoic cystic structure with vascular flow in the left adnexa depicting a tubal pregnancy (single arrow).
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4129173&req=5

fig1: (a) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (b) Longitudinal view: an empty uterus superiorly and pelvic kidney inferiorly (double arrow), free fluid in the cul-de-sac (single arrow). (c) Longitudinal view: ectopically located pelvic kidney with color Doppler (single arrow). (d) Transverse view: hypoechoic cystic structure with vascular flow in the left adnexa depicting a tubal pregnancy (single arrow).
Mentions: A woman G2P0010 in her twenties presented to the emergency room (ER) with a two-day history of nausea and vomiting, severe abdominal pain, vaginal spotting, and a missed menstrual period. Her symptoms began with vaginal spotting two days earlier and were followed with abdominal pain. She reported that the abdominal pain has improved from 10 out of 10 to 2 out of 10 in severity on the visual analog pain scale within the last 24 hours. Besides being diagnosed and adequately treated for genital chlamydia infection in 2006, her past histories are unremarkable. She is a social drinker, smoked cigarettes at a frequency of one pack per day for the last 5 years and also smoked marijuana. On physical examination, she was in no apparent distress with normal vital signs. A mild tenderness to palpation was elicited in the lower abdomen without rebound. Pelvic examination demonstrated a normal 6-week size anteverted but nontender uterus and mild-to-moderately tender left adnexa. The complete blood count was normal. She had a positive urine pregnancy test and a quantitative beta HCG of 1243 mIU/mL. A transvaginal ultrasonography (TVS) showed an empty uterus, a small amount of free fluid in the cul-de-sac, and an incidental left pelvic kidney (Figures 1(a), 1(b), and 1(c)). The patient was deemed stable with minimal pain and therefore was discharged home with instructions to follow up within 48 hours. Thirty-six hours later, she presented to our Institution with similar symptoms. At that time, the beta HCG increased 2673 mIU/mL and a repeat TVS revealed the hitherto diagnosed pelvic kidney, a 3-4 cm mass (Figure 1(d)) in the left adnexa, and an empty uterus with small amount of free fluid in the pelvis.

Bottom Line: Result.Conclusion.Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, C. S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Wayne State University, 275 E. Hancock, Detroit, MI 48201, USA.

ABSTRACT
Objective. To report a case of successful laparoscopic management of a left ruptured tubal pregnancy in the setting of an ipsilateral ectopic pelvic kidney. Method. Case report was prepared at Wayne State University/Detroit Medical Center. The patient is a young woman gravida 2 para 0 in her twenties who presented with severe abdominal pain and vaginal bleeding. She had a plateaued beta HCG and ultrasonographic findings suggestive of ectopic left tubal pregnancy along with an ectopic ipsilateral pelvic kidney. The IRB approval is not needed, as this is a case report. The informed consent could not be obtained, as the patient was not reachable. Result. Multiple intraperitoneal adhesions, left ruptured ampullary ectopic pregnancy and left retroperitoneal pelvic mass consistent with ipsilateral ectopic pelvic kidney. Conclusion. Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney.

No MeSH data available.


Related in: MedlinePlus