Chirculescu Bogdan, Chirculescu Raluca, Ionescu Mioara, Peltecu Gheorghe, Panaitescu Anca
Chirurgia (Bucur). 2017 Jan-Feb;112(1):68-71. doi: 10.21614/chirurgia.112.1.68.
Tubal abortion is characterized by the extrusion of an ectopic product of conception implanted in the fallopian tube through the abdominal ostium into the peritoneal cavity. It can be either complete or incomplete and may lead to severe bleeding. Recognition of a complete tubal abortion may be challenging but is essential because it allows conservative management which make possible preservation of tubal function and fertility without the need for further cytostatic therapy. A case of a 30 years-old woman admitted for lower abdominal pain is reported.The level of hCG was 659.2 mU/mL and transvaginal ultrasound reveled a fluid collection in the pouch of Douglas. Laparoscopy was subsequently performed for the suspicion of ectopic pregnancy with hemoperitoneum. Corroborating the hCG dynamics with the laparoscopic findings, the diagnosis of complete tubal abortion was established. The histopathological examination confirmed the presence of intermediate trophoblastic cells in the tissue collected during laparoscopy. Ultrasound examination helps recognition of hemoperitoneum but adds little value to the diagnosis of tubal abortion. Laparoscopic findings alone are only suggestive for complete tubal abortion but in combination with hCG dynamics, the diagnosis can be established. Conservative management might be sufficient in complete tubal abortion and ensures preservation of tubal function and fertility.
输卵管流产的特征是植入输卵管的异位妊娠产物通过腹腔口被挤出到腹腔内。它可以是完全性的或不完全性的，可能导致严重出血。识别完全性输卵管流产可能具有挑战性，但至关重要，因为它允许进行保守治疗，从而有可能在无需进一步细胞抑制治疗的情况下保留输卵管功能和生育能力。本文报告了一例因下腹部疼痛入院的30岁女性病例。人绒毛膜促性腺激素（hCG）水平为659.2 mU/mL，经阴道超声检查发现Douglas腔有液性暗区。随后因怀疑异位妊娠合并腹腔内出血而进行了腹腔镜检查。结合hCG动态变化与腹腔镜检查结果，确诊为完全性输卵管流产。组织病理学检查证实腹腔镜检查时采集的组织中存在中间型滋养层细胞。超声检查有助于识别腹腔内出血，但对输卵管流产的诊断价值不大。仅腹腔镜检查结果仅提示完全性输卵管流产，但结合hCG动态变化则可确诊。对于完全性输卵管流产，保守治疗可能就足够了，并可确保保留输卵管功能和生育能力。
