抄録
Although ectopic pregnancy tends to be diagnosed in the early phase because of improved technology, we sometimes encounter cases with hypovolumic shock caused by intraabdominal hemorrhage. Here, we report two cases of ectopic pregnancy with intraabdominal hemorrhage that underwent laparoscopic surgery using cell salvage. Case 1 was a woman in her 30s (0 gravida, 0 paras). She visited the clinic previously with lower abdominal pain 8 weeks and 3 days from her last period. She was diagnosed with suspected ectopic pregnancy with intraabdominal hemorrhage and transported to our hospital. Upon arrival, her vitals were the following: blood pressure, 106/56 mmHg; pulse, 100 beats/min; shock index, 0.94; Hb, 8.4 mg/dl; urine hCG, 13,990 IU/l. The postoperative diagnosis was rupture of the right ampulla of tube pregnancy, and laparoscopic right salpingotomy was performed. We collected an intraabdominal hemorrhage amount of 3,336 ml, and 1,484 ml was restored by cell salvage. No blood transfusion was performed. Anemia (Hb, 8.9 mg/dl) was found on postoperative day 1. She was discharged from the hospital on postoperative day 5 with iron infusion. Case 2 was a woman in her 30s (1 gravida, 1 paras). She visited the clinic previously with lower abdominal pain 11 weeks and 2 days from her last period. She was transported to our hospital with interstitial pregnancy with intraabdominal hemorrhage. Her vitals were the following upon arrival: blood pressure, 88/44 mmHg; pulse, 92 times/min; shock index, 1.05; Hb, 9.0 mg/dl. The postoperative diagnosis was rupture of right interstitial pregnancy, and laparoscopic right pars interstitial resection was performed. We collected an intraabdominal hemorrhage amount of 3,260 ml, and 928 ml was restored by cell salvage. No blood transfusion was performed. Anemia (Hb, 9.3 mg/dl) was found on postoperative day 1. She was discharged from the hospital on postoperative day 5 with iron infusion. Blood transfusion by cell salvage can omit crossmatching tests and is thought to be a very useful method for enabling successful laparoscopic surgery with stable blood pressure status.
