A RARE CASE: INTRA-ABDOMINAL PREGNANCY IN THE MESOCOLIC FLEXURE OF THE LIVER

Trương Thanh Thanh1, Trịnh Thanh Nhung1, Phạm Đặng Tấn Hưng1, Hồ Trung Nghĩa1, Châu Hữu Hầu1,
1 Nhat Tan General Hospital

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Abstract

28-year-old pregnant woman, PARA 1001, 10 years of IUD insertion, 2 years of treatment for nephrotic syndrome. Admitted to the hospital because of abdominal pain, acute blood loss. US finding: a lot of abdominal fluid, no gestational sac. Positive pregnancy test, beta hCG 1447 mIU/ml. Diagnosis: Ruptured ectopic pregnancy/Nephrotic syndrome being treated. Treatment: Open surgery with Pfannestiel incision: Right fimbriae must be slightly enlarged with small bleeding points without bleeding, there were many blood clots on the liver, 300 grams of blood clots were removed. Exploring the abdominal cavity wasn't abnormal. Drained and closed the abdomen in 3 layers. After 10 hours of surgery, the patient continued to show signs of acute blood loss, abdominal US finding had moderate free blood. Decided to have laparoscopic surgery to see that the placenta implanted in the mesocolic flexure of the liver was bleeding. We burned and clamped it to stop the bleeding here and sutured the abdomen. Postoperatively, the patient was fine. Conclusion: We draw some experiences as follows: 1. Once the ectopic pregnancy has been identified, try to determine the location of the placenta's implantation. 2. Consider methotrexate or surgery, or a combination of both. 3. Prioritize choosing endoscopic surgery over open surgery. 4. If open surgery, should be operated longitudinally to widen the surgical field, when needed. 5. Obstetrician-Gynecologists and general surgeons should understand the complexities of ectopic pregnancy so that they can sometimes work together to manage them.

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References

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