Korean J Obstet Gynecol.  2012 Jan;55(1):59-63. 10.5468/KJOG.2012.55.1.59.

A case of retroperitoneal ectopic pregnancy

• Yoon SH
• Lee JY
• Yoo MW
• Park SW
• Sohn IS
• Bae JM

• KMID: 1836767
• DOI: http://doi.org/10.5468/KJOG.2012.55.1.59

Abstract

Ectopic pregnancy is an implantation of the fertilized ovum on a place except the endometrium. Most of the ectopic pregnancies are located at the fallopian tube. Only the 1.4% of ectopic pregnancies are abdominal pregnancies, of which only 15 cases of retroperitoneal pregnancies are reported all over the world. In this case, a 21-year-old woman presented with back pain and amenorrhrea for 5+2 weeks with no past history. During the laparoscopic operation, there was retroperitoneal hematoma which was located between right paracolic gutter and presacral area and there was no adnexal mass or free pelvic fluid to be found. We stopped the operation and performed computed tomography angiography, in which small peripheral enhanced cystic lesion in pericaval space and large amount of hematoma in perirenal space were revealed. We performed explo-lapratomy, and eliminated the gestational sac which was located between the inferior vena cava and ureter. We report very rare case of retroperitoneal ectopic pregnancy with brief review of literature.

Keyword

Retroperitoneal ectopic pregnancy

MeSH Terms

Angiography
Back Pain
Endometrium
Fallopian Tubes
Female
Gestational Sac
Hematoma
Humans
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia
Pregnancy
Pregnancy, Abdominal
Pregnancy, Ectopic
Ureter
Vena Cava, Inferior
Young Adult
Zygote
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

• 

  Fig. 1 (A) Retroperitoneal hematoma (8.3 × 3.2cm) was seen by transvaginal sonography. (B) Periumbilical hematoma (10.5 × 4.4cm) was seen by transabdominal sonography.

• 

  Fig. 2 (A) Retroperitoneal hematoma was located between right paracolic gutter and presacral area on diagnostic laparoscopy. (B) Uterus and pelvic peritoneum was intact.

• 

  Fig. 3 Computed tomography angiography showed small peripheral enhanced cystic lesion in pericaval space. (A) Coronal view. (B) Transverse view.

Reference

1. Lin JX, Liu Q, Ju Y, Guan Q, Wu YZ, Zheng N. Primary obturator foramen pregnancy: a case report and review of literature. Chin Med J (Engl). 2008. 121:1328–1330.

2. Takacs P, Chakhtoura N. Laparotomy to laparoscopy: changing trends in the surgical management of ectopic pregnancy in a tertiary care teaching hospital. J Minim Invasive Gynecol. 2006. 13:175–177.

3. Lee JW, Sohn KM, Jung HS. Retroperitoneal ectopic pregnancy. AJR Am J Roentgenol. 2005. 184:1600–1601.

4. Studdiford WF. Primary peritoneal pregnancy. Am J Obstet Gynecol. 1942. 44:487.

5. Reid F, Steel M. An exceptionally rare ectopic pregnancy. BJOG. 2003. 110:222–223.

6. Bae SU, Kim CN, Kim KH, Hwang IT, Choi YJ, Lee MK, et al. Laparoscopic treatment of early retroperitoneal abdominal pregnancy implanted on inferior vena cava. Surg Laparosc Endosc Percutan Tech. 2009. 19:e156–e158.

7. Hall JS, Harris M, Levy RC, Walrond ER. Retroperitoneal ectopic pregnancy. J Obstet Gynaecol Br Commonw. 1973. 80:92–94.

8. Dmowski WP, Rana N, Ding J, Wu WT. Retroperitoneal subpancreatic ectopic pregnancy following in vitro fertilization in a patient with previous bilateral salpingectomy: how did it get there? J Assist Reprod Genet. 2002. 19:90–93.

9. Ferland RJ, Chadwick DA, O'Brien JA, Granai CO 3rd. An ectopic pregnancy in the upper retroperitoneum following in vitro fertilization and embryo transfer. Obstet Gynecol. 1991. 78:544–546.

10. Farquhar CM. Ectopic pregnancy. Lancet. 2005. 366:583–591.

11. Maruri F, Azziz R. Laparoscopic surgery for ectopic pregnancies: technology assessment and public health implications. Fertil Steril. 1993. 59:487–498.

12. Persson J, Reynisson P, Måsbäck A, Epstein E, Saldeen P. Histopathology indicates lymphatic spread of a pelvic retroperitoneal ectopic pregnancy removed by robot-assisted laparoscopy with temporary occlusion of the blood supply. Acta Obstet Gynecol Scand. 2010. 89:835–839.

13. Martínez-Varea A, Hidalgo-Mora JJ, Payá V, Morcillo I, Martín E, Pellicer A. Retroperitoneal ectopic pregnancy after intrauterine insemination. Fertil Steril. 2011. 95:2433.e1–2433.e3.

14. Bradford WZ. Extraperitoneal pregnancy with masive retroperitoneal hemorrhage. Obstet Gynecol. 1958. 11:722–724.

15. Sotus PC. Retroperitoneal ectopic pregnancy: a case report. JAMA. 1977. 238:1363–1364.

16. Terrier JP, Garcia S, Hardwigsen J, D'Ercole C, Andrac-Meyer L, Charpin C. Retroperitoneal ectopic pregnancy: report of a case. Ann Pathol. 1998. 18:201–202.

17. Meire I, van Heusden A, Roukema MS, Niezen RA, Dhont M. A retroperitoneal pregnancy of an anencephalic fetus. J Obstet Gynaecol. 2007. 27:518–519.

18. Iwama H, Tsutsumi S, Igarashi H, Takahashi K, Nakahara K, Kurachi H. A case of retroperitoneal ectopic pregnancy following IVF-ET in a patient with previous bilateral salpingectomy. Am J Perinatol. 2008. 25:33–36.

19. Chang YL, Ko PC, Yen CF. Retroperitoneal abdominal pregnancy at left paracolic sulcus. J Minim Invasive Gynecol. 2008. 15:660–661.