[Hemoperitoneum after early abortion of an abdominal pregnancy--reduced therapeutic options in case of delayed diagnosis].

BACKGROUND

Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious patients in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management.

CASE

A 30- year-old woman (II-gravida, I-para) suffering for about 18 hours from "upper abdominal pain" was found in somnolent and in reduced conditions by her relatives. Unconscious and with all signs of a hemorrhagic shock, she was transferred to the emergency department of the UKBF. After stabilization of circulation, a diagnostic laparoscopy has been performed with the finding of about 2000 ml of coagulated and fresh blood, but without the confirmation of a extrauterine pregnancy (EUP): the small pelvis and his organs were without any signs of EUP. The laparoscopic approach has been changed into a secondary median laparotomy. After exclusion of other reasons for a intraabdominal bleeding (such as spleen rupture or gastrointestinal bleeding), and the complete removal of all intraabdominal blood clots, a embryo, his placenta and the place of placental insertion has been found in the mesenterium jejuni. The surgical procedure was finished in the usual way. The postoperative healing process was uncomplicated.

CONCLUSIONS

Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between placenta and fallopian tubes or ovaries, resp., but definitive insertion of the placenta in the distant peritoneum. In woman in their reproductive age suffering from intraabdominal bleeding, the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient patients history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the early abortion of a abdominal pregnancy has to be made by open surgery.