Yamamoto Shinji, Nelander Maria
Department of Surgical Sciences, Uppsala University, and Division of transplantation, Department of surgery, Uppsala University Hospital, Uppsala, SE-75185, Sweden.
Department of Women's and Childreńs health, Uppsala University, and Department of Women's health care, Uppsala University Hospital, Uppsala, Sweden.
Int J Surg Case Rep. 2016;28:152-154. doi: 10.1016/j.ijscr.2016.09.049. Epub 2016 Sep 30.
We present a case report of ectopic pregnancy (EP) after simultaneous pancreas-kidney transplantation (SKPTx).
A 33-year-old female status post SKPTx suddenly got abdominal pain in the lower level. She had high human chorionic Gonadotropin test. Ultrasonography revealed that there was no fetus in the uterus but a dilated right fallopian tube, which strongly suggested ectopic pregnancy. An emergency operation was performed and a dilated right side uterine tube was found with adhesions to her transplant. Salpingectomy was performed and no visible injury to the pancreas was found by the procedure. Pathological evaluation showed ectopic pregnant fetus, and no pancreas dysfunction was observed after the operation.
This is the first case and operation report of EP after SKPTx. We should consider various causes of acute abdomen as well as several pathological condition in the transplanted pancreas such as pancreatitis, abscess, and thrombosis in vessels in the organ. Moreover, transplanted pancreas in abdomen is easily misrecognized as adipose tissue and there is high risk that the organ to get injured surgically.
EP should be included in the different diagnosis in SKPTx female patients who get acute abdominal pain. It is highly desirable that transplant surgeon is included in the operation team for EP of these patients.
我们报告一例胰肾联合移植(SKPTx)后发生异位妊娠(EP)的病例。
一名33岁女性在接受SKPTx后突然出现下腹部疼痛。她的人绒毛膜促性腺激素检测结果呈阳性。超声检查显示子宫内未见胎儿,但右侧输卵管扩张,强烈提示异位妊娠。遂进行急诊手术,发现右侧输卵管扩张并与移植器官粘连。行输卵管切除术,术中未发现胰腺有明显损伤。病理评估显示为异位妊娠胎儿,术后未观察到胰腺功能障碍。
这是首例关于SKPTx后发生EP的病例及手术报告。我们应考虑急性腹痛的各种原因以及移植胰腺的几种病理状况,如胰腺炎、脓肿和器官血管血栓形成。此外,腹腔内的移植胰腺容易被误诊为脂肪组织,手术中该器官有很高的受伤风险。
对于出现急性腹痛的SKPTx女性患者,异位妊娠应纳入鉴别诊断。对于这些患者的异位妊娠手术,非常有必要让移植外科医生加入手术团队。