自然周期での腹腔妊娠を伴う子宮内外同時妊娠に対して腹腔鏡手術を施行した1例

抄録

Objective: Both abdominal pregnancy and heterotopic pregnancy are rare, and rupture in ectopic pregnancy can be fatal. We report successful laparoscopic surgery for an abdominal pregnancy in a case of spontaneous heterotopic pregnancy.

Case: The patient was a 29-year-old woman, G1P0. She had undergone intrauterine curettage for inevitable abortion at 6 weeks of pregnancy in another hospital. Pathological findings indicated villi in the uterine contents. She presented at our hospital with acute abdominal pain 3 weeks after the operation. Transvaginal ultrasound confirmed massive bleeding in both the pouch of Douglas and vesicouterine pouch. We suspected rupture of ectopic pregnancy, as the serous human chorionic gonadotropin (hCG) level was still high. We performed laparoscopic surgery that revealed abdominal pregnancy at fundus of uterus. Complete removal of the pregnancy site was performed through laparoscopic surgery, and the serous hCG level decreased after the operation. Pathological findings indicated villi in the pregnancy site below the uterus. The serous hCG level was in the normal range 56 days after the surgery.

Conclusion: Given that both abdominal pregnancy and heterotopic pregnancy can be fatal, careful examination is vital in the early stages of pregnancy. Although laparoscopic surgery for abdominal pregnancy is a treatment option, this should be changed to laparotomy when there is uncontrolled bleeding from the pregnancy site. Chemotherapy and embolization may also be an option for abdominal pregnancy when complete removal of the pregnancy site is difficult.