卵管妊娠の疑いで腹腔鏡下手術を行い腹膜妊娠の診断・治療し得た２例

抄録

　Peritoneal pregnancies are rare, accounting for approximately 1% of ectopic pregnancies and 0.01% of all pregnancies. This report discusses two cases initially diagnosed as tubal ectopic pregnancies, which upon laparoscopic surgery, were identified as peritoneal pregnancies. Case 1 involved a 29-year-old woman, gravida 0, who was referred to our hospital due to suspected ectopic pregnancy. Serum hCG level was 2,255 mIU/ml. Transvaginal ultrasonographic examination did not detect a gestational sac in the uterus, but identified a hematoma around the right ovary. Diagnosis indicated a right tubal ectopic pregnancy, leading to laparoscopy. Approximately 52 ml of blood and a gestational sac were observed on the uterine serosal surface. Complete removal of gestational tissue and villi resulted in her smooth recovery. Case 2 involved a 43-year-old pregnant woman post in vitro fertilization, gravida 1 para 0, referred to our hospital with a serum hCG level of 2,289 mIU/ml. Transvaginal ultrasonography revealed a gestational sac in the right fallopian tube but not in the uterus. Laparoscopy indicated little blood in pelvis and uncovered a gestational sac and clot on the vesicouterine pouch. Resection of these tissues and villi revealed a peritoneal pregnancy. Preoperative diagnosis of peritoneal pregnancy remained challenging in both the cases, underscoring the diagnostic and therapeutic utility of laparoscopic surgery in such instances.