Delayed diagnosis of a heterotopic pregnancy as a cause of acute abdomen: A case report

Öz

Introduction: Heterotopic pregnancy is a life threating condition of intrauterine and extrauterine gestations which occur at the same time. We report a delayed diagnosed case of heterotopic pregnancy. Case: A 31 year-old primigravida was referred to our Emergency Gynaecology Service complicated by acute abdomen. She had been treated with clomiphene citrate and on admission intrauterine a missed abortus of about 8 weeks complicated by a large subchorionic hematoma was detected. Emergency laparotomy was performed because of diffuse intra-abdominal haemorrhage. A right-sided ectopic focus was recognized and excised, and dilatation - curettage was performed. Coclusion: Delay in diagnosing the condition can be fatal to both the mother and the intrauterine fetus.

Anahtar Kelimeler

• Heterotopic pregnancy, delayed diagnosis, acute abdomen

Geç Tanı Almış Akut Batına Neden Olan Heterotropik Gebelik: Olgu Sunumu

Öz

Heterotropik gebelik, intrauterine ve ekstrauterin gebeliğin bir arada olduğu hayatı tehdit eden bir durumdur. Bu yazıda tanısı geç konulmuş bir heterotropik gebelik olgusu sunulmuştur. 31 yaşında ilk gebeliği olan hasta akut batın nedeniyle acil servise başvurdu. Klomifen sitrat ile ovulasyon indüksiyonu sonrası oluşan missed abortus ve geniş subkoryonik hematom alanı ile komplike 8 hafta ile uyumlu gebelik mevcuttu. Hastaya yaygın intraabdominal kanaması olması sebebiyle acil laparotomi uygulandı. Sağ tuba yerleşimli rüptüre ektopik gebelik izlenmiş olup ektopik gebelik eksizyonu ve dilatasyon küretaj uygulandı. Heterotropik gebelikte geç tanı konulması maternal ve intrauterine yerleşimli fetus için fatal seyirli olabilir.

Anahtar Kelimeler

• Heterotropik gebelik, gecikmiş tanı, akut karın

Kaynakça

1. Thakur R, El-Menabawey M. Combined intra-uterine and extrauterine pregnancy associated with mild hyperstimulation syndrome after clomiphene ovulation induction. Hum Reprod 1996;11(7):1583-4.
2. Jan F, Naikoo GM, Rather HM, Sheikh TA, Rather YH. Ruptured heterotopic pregnancy: a rare case for hemoperitoneum; report of three cases from Kashmir, India. Indian J Surg 2010;72(5);404-6.
3. DeFrancesch F, DiLeo L, Martinez J. Heterotopic pregnancy: discovery of ectopic pregnancy after elective abortion. South Med J 1999;92(3):330-2. Beyer DA, Dumesic DA. Heterotopic pregnancy: an emerging diagnostic challenge. OBG Management 2002;14(10):36-46.
4. Hassiakos D, Bakas P, Pistofidis G, Creatsas G. Heterotopic pregnancy at 16 weeks of estation after in-vitro fertilization and embryo transfer. Arch Gynecol Obstet 2002;266(3):124-5.
5. Basile F, Di Cesare C, Quagliozzi L, Donati L, Bracaglia M, Caruso A, Paradisi G. Spontaneous heterotopic pregnancy, simultaneous ovarian and intrauterine: a case report. Case Rep Obstet Gynaecol 2012;2012:1-4.
6. Erten O, Dede H, Kurtaran V, Yirci B, Gelisen O, Goktolga U. Ruptured spontaneous heterotropic pregnancy. J Turk Soc Obstet Gynecol 2012;9(4):227
7. Salman S, Duman O, Arici B, Bozyigit A, Sever AM, Ayanoğlu YT. Primary omental heterotopic pregnancy in a spontaneous cycle: case report. Turkiye Klinikleri J Gynecol Obst 2012;22(4):275-8.