Ota Kuniaki, Takahashi Toshifumi, Ota Yoshiaki, Saito Wataru, Nishimura Hirotake, Moriya Takuya, Shimoya Koichiro
Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama 701-0192, Japan; Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima 960-1295, Japan.
Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima 960-1295, Japan.
Int J Surg Case Rep. 2025 Aug;133:111647. doi: 10.1016/j.ijscr.2025.111647. Epub 2025 Jul 10.
Ovarian pregnancy is a rare form of ectopic pregnancy, accounting for approximately 3 % of cases, with an incidence ranging from 1 in 2100 to 1 in 7000 pregnancies. Its diagnosis is challenging due to nonspecific symptoms and difficulty distinguishing it from corpus luteum cysts or tubal pregnancies. Delayed recognition can lead to life-threatening hemorrhage.
A 34-year-old gravida 3 para 3 Japanese woman presented with acute abdominal pain and hypovolemic shock 33 days after her last menstrual period. Imaging revealed a right ovarian cystic mass, intra-abdominal bleeding, and an empty uterus. Emergency laparoscopy identified a 5-mm gestational sac-like lesion on the right ovary. Laparoscopic wedge resection was performed. Pathological analysis confirmed extravillous trophoblast invasion into ovarian stromal vessels. A corpus luteum was observed at a separate location, supporting the diagnosis of secondary extrafollicular ovarian pregnancy. The patient recovered uneventfully.
Ovarian pregnancies are classified as primary or secondary, and intrafollicular or extrafollicular. This case demonstrated secondary extrafollicular implantation with vascular invasion. Updated diagnostic criteria emphasize intact fallopian tubes, hemorrhagic ovarian lesions, and pregnancy tissue identification. Early detection remains difficult, particularly before 5 weeks gestation, and diagnosis often requires surgical and pathological confirmation.
This case underscores the importance of early recognition and laparoscopic management of ovarian pregnancy. Pathological findings aid in understanding implantation mechanisms and differentiating from similar adnexal conditions. Minimally invasive surgery enabled successful hemostasis and fertility preservation. Improved clinical awareness is essential to reduce complications associated with this rare condition.
卵巢妊娠是一种罕见的异位妊娠形式，约占病例的3%，发病率在每2100次妊娠中有1例至每7000次妊娠中有1例之间。由于症状不具特异性且难以与黄体囊肿或输卵管妊娠区分开来，其诊断具有挑战性。识别延迟可能导致危及生命的出血。
一名34岁、孕3产3的日本女性，在末次月经后33天出现急性腹痛和低血容量性休克。影像学检查显示右侧卵巢有一个囊性肿块、腹腔内出血以及子宫空虚。急诊腹腔镜检查发现右侧卵巢有一个5毫米的妊娠囊样病变。进行了腹腔镜楔形切除术。病理分析证实绒毛外滋养细胞侵入卵巢间质血管。在另一个位置观察到一个黄体，支持继发性卵泡外卵巢妊娠的诊断。患者顺利康复。
卵巢妊娠分为原发性或继发性，以及卵泡内或卵泡外。该病例显示为伴有血管侵犯的继发性卵泡外着床。更新后的诊断标准强调输卵管完整、卵巢出血性病变以及妊娠组织的识别。早期检测仍然困难，尤其是在妊娠5周之前，诊断通常需要手术和病理证实。
该病例强调了早期识别和腹腔镜治疗卵巢妊娠的重要性。病理结果有助于理解着床机制并与类似的附件疾病相鉴别。微创手术实现了成功止血并保留了生育能力。提高临床意识对于减少与这种罕见疾病相关的并发症至关重要。
