「異所性妊娠と誤診し腹腔鏡下手術を行った例に関する検討」−異所性妊娠の診断におけるpit fall−

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Objective: We retrospectively reviewed medical records to investigate the pattern of pitfalls in the diagnosis of ectopic pregnancy (EP) after laparoscopic surgery.
Study Design: From April 2009 through June 2013, 280 women with suspected EP were admitted to our hospital. We retrospectively reviewed the medical records of all these cases in regard to clinical symptoms, serum hCG level, transvaginal ultrasonographic findings, intraoperative findings, and pathological findings.
Results: Among 280 cases of suspected EP, 175 cases underwent laparoscopic surgery, and 18 of these cases (10.3%) were not EP. The distribution of these non-EP cases was: nine cases of spontaneous abortion, four cases of pregnancy with unknown implantation site, three cases of ovarian hemorrhage, and two cases of normal pregnancy. Among these 18 cases, 12 cases underwent laparoscopic surgery without a preceding dilatation and Curettage (D&C), and the remaining six cases underwent a preceding D&C. Among the 18 cases, 11 cases had a tumor mass imaged outside the uterus misdiagnosed as a gestational sac. Normal pregnancy (two cases) and unspecified implantation site (one case) exhibited an anechoic area in the pouch of Douglas, which was laparoscopically diagnosed as ascites.
Conclusions: A misdiagnosis of EP may occur in women with suspected EP. A diagnosis of EP should be considered in women who clinically manifest as spontaneous abortion, unknown implantation site, ovarian hemorrhage, and/or early pregnancy. Accordingly, in the case of an anechoic area in the pouch of Douglas, we recommend the performance of a culdocentesis for the determination of the correct diagnosis. A thorough explanation should be given to the patient that a misdiagnosis is possible even with careful clinical evaluation.