A rare case of abdominal pregnancy

An extrauterine abdominal pregnancy is a very rare form of ectopic pregnancy in which implantation occurs within the peritoneal cavity, and outside the fallopian tube and ovary. It easily causes misdiagnosis and is closely related to maternal health. Only a few reported cases have been treated using laparoscopy. The authors report a case involving an extrauterine abdominal pregnancy diagnosed during laparoscopy located near the rectum. A 39-year-old gravida 3 para 1 who had a cesarean delivery 16 years ago was referred to the present department for evaluation of vaginal bleeding for 47 days. No abdominal tenderness was demonstrated on physical examination. The vaginal examination revealed an enlarged uterus. An ultrasound scan showed an empty uterine cavity. Adjacent to the right ovary, a mixed echo was noted in which a yolk sac was visible. A heart rate was detected. The serum beta hCG was 11,198 mIU/mL. Laparoscopic surgery was performed. On the right side of the sacral ligament there was a 3x3 x2.5 cm purple-blue mass adherent to the rectum. The pregnancy was excised and removed from the abdomen in an endo-bag, and hemostasis was assured. During the postoperative course, intramuscular methotrexate therapy was administered (20 mg/m(2) twice a week x5). The patient was discharged on the 26th postoperative day; she was asymptomatic and had no complaints. The serum beta hCG level was 3.98 IU/1 at the time of discharge. This case shows that laparoscopic treatment of abdominal pregnancy is safe and feasible, and when necessary, can assist drug therapy.