Successful laparoscopic management of abdominal pregnancy in the pouch of Douglas: a case report

Case Report: A 27-year-old gravida 0 woman was referred to our hospital because of lower abdominal and anal pain. Transvaginal ultrasonography showed no gestational sac in the pelvis, and a hypoechoic lesion suspicious for a pelvic hematoma was seen in the cul-de-sac. Serum hCG level was 472.2 mIU/ml, and hemoglobin level was 11.0 g/dl. She had signs of peritoneal irritation. Therefore, we performed laparoscopy, which showed that the uterus, bilateral tubes, and both ovaries were entirely unremarkable. There were approximately 300 ml of blood and clots in the peritoneal cavity. On further exploration, there was a small bleeding site in the cul-de-sac, which was a suspected implantation site. Slight active bleeding was controlled by cauterizing the site using bipolar forceps. All clots were aspirated and sent for pathological examination, which revealed the presence of chorionic villi and trophoblastic and mesothelial cells, confirming a primary abdominal pregnancy. Her postoperative course was uneventful, and the patient was discharged on the 5th postoperative day with serum hCG level of 66.3 mIU/ml. In the month after surgery, the serum hCG level rapidly declined. In this case, the clinical findings met the criteria used to diagnose a primary abdominal pregnancy described by Suddiford, and the laparoscopic procedure was effective for diagnosis and treatment of peritoneal pregnancy.