腹膜妊娠を伴う正所異所同時妊娠に対して腹腔鏡下手術を行った一例

抄録

　This report describes a rare case of simultaneous intrauterine and Douglas fossa peritoneal pregnancy after artificial insemination, treated by laparoscopy. The patient was 35 years old with a history of two pregnancies and one delivery. The pregnancy was achieved by ovulation induction and artificial insemination. At seven weeks' gestation, she developed lower abdominal pain. Transvaginal ultrasound revealed a suspected heterotopic pregnancy in the uterus and left fallopian tube, along with massive intra-abdominal bleeding. Emergency laparoscopic surgery was performed. A uterine manipulator could not be used and the Douglas fossa was not visible. A 2-0 Prolene suture with a straight needle was punctured through the left abdominal wall. The needle was advanced intraperitoneally to the right epiploic appendices to suspend the sigmoid colon and secure the visual field. No abnormalities were found in the bilateral adnexa. A chorionic component was found implanted in the peritoneum of the Douglas fossa, diagnosed as a peritoneal pregnancy. Adequate exposure allowed blunt dissection of the tissue and hemostasis to be achieved without injury to surrounding organs. Postoperative recovery was uneventful and the patient delivered a healthy baby at 38 weeks' gestation. Peritoneal pregnancies are difficult to diagnose and have a higher mortality risk than other ectopic sites. In this case, the peritoneal pregnancy had ruptured, resulting in hemorrhagic shock, and laparoscopic surgery was performed. Sigmoid colon elevation provided adequate exposure, allowing safe removal of the villous tissue and hemostasis.