Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Online) |
Texto Completo: | http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/799 |
Resumo: | Heterotopic pregnancy (HP) is the coexistence of intrauterine (IU) and extrauterine (EU) gestation. It is rare and potentially fatal condition if not correctly treated or diagnosed. In this case report, we present a 33-year-old woman with a 16-week topical pregnancy with spontaneous rupture of an ectopic pregnancy (EP) in the uterine tube. At first, the patient had diffused abdominal pain, specifically in the lower abdominal level and tachycardia. The evaluation of the fetus showed no signs of distress. Abdominal and transvaginal ultrasound (US) show free intraperitoneal fluid, a normal-looking IU gestation with a positive fetal heart rate consistent with a fetal age of approximately 16 weeks, signs of parenchymal vascular hypoflux of the spleen on the color doppler study, associated with a splenic vein with low vascular amplitude flow. General surgery team were requested and to rule out aneurysm of splenic vessels as a source of bleeding she had an abdominal angiotomography that showed a moderate amount of free fluid, ectasia of gonadal and uterine vessels, with no signals of active bleeding and no spleen changes. No signs of EP were identified in this exam. The patient had hemodynamic deterioration with maintenance of abdominal girth. An emergency exploratory laparotomy was performed under general anesthesia through a supra and subumbilical incision, leading to a finding of a ruptured EP. There was a 3 cm right tubal ruptured ectopic pregnancy. A total right salpingectomy was performed with removal of the hemoperitoneum and peritoneal lavage. The patient recovered uneventfully and was discharged from the hospital within 5 days. |
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Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report Ruptured spontaneous heterotopic pregnancy with hemoperitoneum: a case report / Gravidez heterotópica rota espontânea apresentando hemoperitônio: relato de casoHeterotopic pregnancy (HP) is the coexistence of intrauterine (IU) and extrauterine (EU) gestation. It is rare and potentially fatal condition if not correctly treated or diagnosed. In this case report, we present a 33-year-old woman with a 16-week topical pregnancy with spontaneous rupture of an ectopic pregnancy (EP) in the uterine tube. At first, the patient had diffused abdominal pain, specifically in the lower abdominal level and tachycardia. The evaluation of the fetus showed no signs of distress. Abdominal and transvaginal ultrasound (US) show free intraperitoneal fluid, a normal-looking IU gestation with a positive fetal heart rate consistent with a fetal age of approximately 16 weeks, signs of parenchymal vascular hypoflux of the spleen on the color doppler study, associated with a splenic vein with low vascular amplitude flow. General surgery team were requested and to rule out aneurysm of splenic vessels as a source of bleeding she had an abdominal angiotomography that showed a moderate amount of free fluid, ectasia of gonadal and uterine vessels, with no signals of active bleeding and no spleen changes. No signs of EP were identified in this exam. The patient had hemodynamic deterioration with maintenance of abdominal girth. An emergency exploratory laparotomy was performed under general anesthesia through a supra and subumbilical incision, leading to a finding of a ruptured EP. There was a 3 cm right tubal ruptured ectopic pregnancy. A total right salpingectomy was performed with removal of the hemoperitoneum and peritoneal lavage. The patient recovered uneventfully and was discharged from the hospital within 5 days.Abstract Introduction: Heterotopic pregnancy (HP) is the coexistence of intrauterine (IU) and extrauterine (EU) gestation. It is a rare and potentially fatal condition if not correctly treated or diagnosed. Case Report: We present a 33-year-old woman with a 16-week topical pregnancy with spontaneous rupture of an ectopic pregnancy (EP) in the uterine tube. At first, the patient had diffuse abdominal pain, specifically in the lower abdominal level and tachycardia. The evaluation of the fetus showed no signs of distress. Abdominal and transvaginal ultrasound (US) showed free intraperitoneal fluid, a normal aspect IU gestation with a positive fetal heart rate, consistent with a fetal age of approximately 16 weeks, signs of parenchymal vascular hypoflux of the spleen on the color Doppler study, associated with a splenic vein with low vascular amplitude flow. General surgery team was requested and in order to rule out aneurysm of splenic vessels as a source of bleeding, she had an abdominal angiotomography that showed a moderate amount of free fluid, ectasia of gonadal and uterine vessels, with no signals of active bleeding and no spleen changes. No signs of EP were identified in the exam. The patient presented hemodynamic deterioration with maintenance of abdominal girth. An emergency exploratory laparotomy was performed under general anesthesia through a supra and infraumbilical incision, leading to a finding of a ruptured EP. There was a 3-cm right tubal ruptured ectopic pregnancy. A total right salpingectomy was performed with removal of the hemoperitoneum and peritoneal lavage. The patient recovered uneventfully and was discharged from the hospital within 5 days. Conclusion: Heterotopic pregnancy should be kept in mind even if an intrauterine pregnancy is diagnosed. Keywords: Heterotopic pregnancy, Hemoperitoneum/surgery Resumo Introdução: A gravidez heterotópica (HP) é a coexistência da gestação intrauterina (IU) e extrauterina (EU). É uma condição rara e potencialmente fatal se não tratada ou diagnosticada corretamente. Relatamos uma emergência cirúrgica numa gestante de 33 anos com uma gravidez tópica de 16 semanas e ruptura espontânea de uma gravidez ectópica (GEC) na tuba uterina, submetida a cirurgia e ressecção da tuba sem complicações de gravidez uterina. Relato de Caso: Uma mulher de 33 anos, G3P2, com 16 semanas de gestação, foi ao serviço de emergência obstétrica (SEO) devido a dores abdominais por uma semana. No início, a paciente tinha dor abdominal difusa, especificamente no abdome inferior e taquicardia. A avaliação do feto não mostrou sinais de sofrimento. Foi realizado um ultrassom abdominal e transvaginal (USA), que demonstrou líquido livre e uma gestação IU de aparência normal, com uma frequência cardíaca fetal positiva, consistente com uma idade fetal de aproximadamente 16 semanas, um baço com dimensões, morfologia e ecotextura habituais, com sinais de hipofluxo vascular no estudo doppler, associado a uma veia esplênica com baixa amplitude do fluxo vascular. Uma vez que paciente se encontrava hemodinamicamente estável, foi optado pela realização de angiotomografia abdominal para descartar aneurisma roto de artéria esplênica como fonte de sangramento. Considerando a gravidade da anemia, ela recebeu 02 unidades de hemoconcentrado. A tomografia mostrou piora da quantidade moderada de líquido livre, ectasia de vasos gonadais e uterinos, sem sinais de sangramento ativo e sem alterações no baço. Não foram identificados sinais de gestação IU neste exame. O paciente apresentou alteração hemodinâmica e mantinha dor abdominal. Foi realizada uma laparotomia exploradora de emergência sob anestesia geral através de uma incisão supra e infraumbilical, evidenciando 2 L de sangue na cavidade e GEC rota na tuba a direita com cerca de 3 cm de extensão. Foi realizada uma salpingectomia direita com a remoção do hemoperitônio e lavagem da cavidade. A paciente se recuperou sem intercorrências e teve alta do hospital em 5 dias. Conclusão: A gravidez heterotópica deve ser mantida em mente, mesmo se uma gravidez intrauterina for diagnosticada. Palavras chave: Gavidez heterotópica, Hemoperitônio/cirurgiaFaculdade de Ciências Médicas da Santa Casa de São Paulo2022-05-19info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/79910.26432/1809-3019.2022.67.003Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo; V. 67 (2022): Jan/Dez; 1 of 41809-30190101-6067reponame:Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Online)instname:Faculdade de Ciências Médicas da Santa Casa de São Pauloinstacron:FCMSCSPenghttp://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/799/1121Copyright (c) 2022 Caroline Petersen da Costa Ferreira; Henrique Cunha Mateus, Augusto Canton Gonçalves, Rodrigo Jaqueto Nomura, Bruna Nascimento Crouzillard, Bruno Hirata, José Cesar Assefhttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessFerreira, Caroline Petersen da Costa Mateus, Henrique CunhaGonçalves, Augusto CantonNomura, Rodrigo Jaqueto Crouzillard, Bruna Nascimento Hirata, Bruno Henrique Nunes Assef, José Cesar 2022-05-24T19:45:06Zoai:ojs2.arquivosmedicos.fcmsantacasasp.edu.br:article/799Revistahttp://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSPONGhttp://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/oaiarquivosmedicos@fcmsantacasasp.edu.br||1809-30190101-6067opendoar:2022-05-24T19:45:06Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Online) - Faculdade de Ciências Médicas da Santa Casa de São Paulofalse |
dc.title.none.fl_str_mv |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report Ruptured spontaneous heterotopic pregnancy with hemoperitoneum: a case report / Gravidez heterotópica rota espontânea apresentando hemoperitônio: relato de caso |
title |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report |
spellingShingle |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report Ferreira, Caroline Petersen da Costa |
title_short |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report |
title_full |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report |
title_fullStr |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report |
title_full_unstemmed |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report |
title_sort |
Ruptured Spontaneous Heterotopic Pregnancy Presenting with Hemoperitoneum: a case report |
author |
Ferreira, Caroline Petersen da Costa |
author_facet |
Ferreira, Caroline Petersen da Costa Mateus, Henrique Cunha Gonçalves, Augusto Canton Nomura, Rodrigo Jaqueto Crouzillard, Bruna Nascimento Hirata, Bruno Henrique Nunes Assef, José Cesar |
author_role |
author |
author2 |
Mateus, Henrique Cunha Gonçalves, Augusto Canton Nomura, Rodrigo Jaqueto Crouzillard, Bruna Nascimento Hirata, Bruno Henrique Nunes Assef, José Cesar |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Ferreira, Caroline Petersen da Costa Mateus, Henrique Cunha Gonçalves, Augusto Canton Nomura, Rodrigo Jaqueto Crouzillard, Bruna Nascimento Hirata, Bruno Henrique Nunes Assef, José Cesar |
description |
Heterotopic pregnancy (HP) is the coexistence of intrauterine (IU) and extrauterine (EU) gestation. It is rare and potentially fatal condition if not correctly treated or diagnosed. In this case report, we present a 33-year-old woman with a 16-week topical pregnancy with spontaneous rupture of an ectopic pregnancy (EP) in the uterine tube. At first, the patient had diffused abdominal pain, specifically in the lower abdominal level and tachycardia. The evaluation of the fetus showed no signs of distress. Abdominal and transvaginal ultrasound (US) show free intraperitoneal fluid, a normal-looking IU gestation with a positive fetal heart rate consistent with a fetal age of approximately 16 weeks, signs of parenchymal vascular hypoflux of the spleen on the color doppler study, associated with a splenic vein with low vascular amplitude flow. General surgery team were requested and to rule out aneurysm of splenic vessels as a source of bleeding she had an abdominal angiotomography that showed a moderate amount of free fluid, ectasia of gonadal and uterine vessels, with no signals of active bleeding and no spleen changes. No signs of EP were identified in this exam. The patient had hemodynamic deterioration with maintenance of abdominal girth. An emergency exploratory laparotomy was performed under general anesthesia through a supra and subumbilical incision, leading to a finding of a ruptured EP. There was a 3 cm right tubal ruptured ectopic pregnancy. A total right salpingectomy was performed with removal of the hemoperitoneum and peritoneal lavage. The patient recovered uneventfully and was discharged from the hospital within 5 days. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-05-19 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/799 10.26432/1809-3019.2022.67.003 |
url |
http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/799 |
identifier_str_mv |
10.26432/1809-3019.2022.67.003 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/799/1121 |
dc.rights.driver.fl_str_mv |
https://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
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https://creativecommons.org/licenses/by/4.0 |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Faculdade de Ciências Médicas da Santa Casa de São Paulo |
publisher.none.fl_str_mv |
Faculdade de Ciências Médicas da Santa Casa de São Paulo |
dc.source.none.fl_str_mv |
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo; V. 67 (2022): Jan/Dez; 1 of 4 1809-3019 0101-6067 reponame:Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Online) instname:Faculdade de Ciências Médicas da Santa Casa de São Paulo instacron:FCMSCSP |
instname_str |
Faculdade de Ciências Médicas da Santa Casa de São Paulo |
instacron_str |
FCMSCSP |
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FCMSCSP |
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Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Online) |
collection |
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Online) |
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Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Online) - Faculdade de Ciências Médicas da Santa Casa de São Paulo |
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arquivosmedicos@fcmsantacasasp.edu.br|| |
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