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Case Report
A rare case of early abdominal pregnancy (EAP)
1 MBChB, BMedSci, Foundation Year Two doctor, University Hospitals Sussex Trust, Brighton, Sussex, United Kingdom
2 MD, MRCOG, Senior clinical fellow, Kingston Hospitals NHS Trust, Kingston upon Thames, London, United Kingdom
3 FRCOG, MSc in Advanced Gynaecological Endoscopy, Consultant Obstetrics and Gynaecology, Frimley Health NHS Foundation Trust, Frimley, Surrey, United Kingdom
Address correspondence to:
Marta Mungai Ndungu
64B Springfield Road, Brighton, Sussex BN1 6DE,
United Kingdom
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Article ID: 100183Z08MN2024
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How to cite this article
Ndungu MM, Thing R, Sankaran S. A rare case of early abdominal pregnancy (EAP). J Case Rep Images Obstet Gynecol 2024;10(2):34–40.ABSTRACT
Introduction: Abdominal pregnancy comprises 1% of ectopic pregnancies and is challenging to manage due to the associated significant morbidity and mortality. Abdominal pregnancy may be classified according to gestation and implantation site. Ultrasound imaging is the mainstay of diagnosis. Confirmatory tests include magnetic resonance imaging (MRI) and diagnostic laparoscopy.
Case Report: A 36-year-old patient, amenorrheic for 9–10 weeks, presented to the early pregnancy unit complaining of a one-day history of abdominal pain associated with an episode of vomiting. She denied vaginal bleeding and examination revealed left lower quadrant tenderness. Ultrasound imaging demonstrated a live abdominal pregnancy around 12 weeks’ gestation implanted on the left uterine surface. Following appropriate counselling, she opted for surgical management and consented to the termination of pregnancy. She underwent diagnostic laparoscopy which confirmed that the gestational sac was arising from the left lateral uterine angle and was densely adherent to the omentum and bowel. The procedure was converted to laparotomy to enable safe adhesiolysis and excision of the entire gestational sac. Postoperatively, she represented on day 12 with abdominal pain, fever and bleeding. Computed tomography of abdomen and pelvis (CT-AP) suggested left ureteric injury and she underwent retrograde double J urethral stent (JJ stenting) of the left ureter. Fortunately, the same healed with conservative management.
Conclusion: Abdominal pregnancy is rare and poses challenges in diagnosis and management. Once diagnosed, urgent surgical management is recommended given the high risk of complications including intra-abdominal bleeding and visceral injury. Therefore, each case requires a careful and considered treatment approach by a multi-disciplinary team.
Keywords: Abdominal pregnancy, Ectopic pregnancy, Non-tubal ectopic, Rare ectopic pregnancy
SUPPORTING INFORMATION
Acknowledgments
Thank you to Frimley Park Hospital EPU.
Author ContributionsMarta Mungai Ndungu - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rakesh Thing - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sridevi Sankaran - Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementVerbal informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Marta Mungai Ndungu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
