Kornual gebelikte laparoskopik tedavi: Olgu sunumu

Öz

Kornual veya interstisyel gebelik insidansı tüm gebeliklerin yaklaşık %2'sidir. İnterstisyel gebelik, tüm ektopik gebeliklerin %1-6'sı ile nadir görülen ektopik gebeliklerden biridir. Olgumuzda, pozitif fetal kardiyak aktivite gözlenen kornual ektopik olgusunun başarılı bir şekilde laparoskopik rezeksiyonu ve kornu uterinin laparoskopik sütüre edildiği olguyu sunuyoruz. 26 yaşında hamile; gravida 2, para 0, abort 1; sol alt kadran karın ağrısı şikayeti ile başvurdu. Ultrason muayenesi yapıldı. Ultrason muayenesinde sol adnekste pozitif kardiyak aktivite gösteren 4 cm'lik bir ektopik gebelik kesesi saptandı. Laparoskopi planlandı. Solda uterin kornuda, yaklaşık 3x4 cm kornual gebelik görüldü, 5 mm'lik bir koter disektör, cornu uteri'nin rezeksiyonu ve mühürlenmesi için kullanıldı. Sonrasında, iki kez laparoskopik dikiş atıldı. İnterstisyel gebeliği tespit etmek, diğer ektopik gebelik tiplerini ortaya koymaktan daha zordur. Cornu uteri'nin rezeksiyonu sırasında ciddi kanamalar görülebilir. Bu nedenle, laparoskopik bir yaklaşım, ancak cerrah laparoskopik teknikte uzmansa ve operasyonu hızlı bir şekilde laparotomiye dönüştürme yeteneğine sahipse denenmelidir.

Anahtar Kelimeler

• Laparoskopi,Ektopik gebelik,Kornual gebelik

Laparoscopic management of cornual pregnancy: A case report

Abstract

The incidence of cornual or interstitial pregnancy is approximately 2% of all pregnancies. Interstitial pregnancy is one of the rare form of ectopic pregnancies, with 1-6% of all ectopic pregnancies. In our case report, we present successful laparoscopic resection of a cornual pregnancy with positive fetal cardiac activity and laparoscopic suturing of cornu uteri. A 26-year-old pregnant; gravida 2, para 0, abortus 1; was admitted with a complaint of left lower quadrant abdominal pain. An ultrasound examination was performed. The ultrasound examination revealed a 4-cm ectopic gestational sac with positive cardiac activity in the left adnexa. Laparoscopy was planned. A left uterin approximately 3x4 cm cornual pregnancy was observed, under direct visualization, one 5-mm coagulating dissector was used to perform the resection and seal of the cornu uteri. After the sealing, two times laparoscopic suturing was applied. Detecting interstitial pregnancy is more difficult than revealing other ectopic pregnancy types. Severe hemorrhage could occur during the resection of the cornu uteri. Therefore, a laparoscopic approach should only be attempted if the surgeon is well skilled in laparoscopic technique, and has the capability to convert the operation quickly to a laparotomy.

Keywords

• Laparoscopy,Ectopic pregnancy,Cornual pregnancy

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