Laparoscopic Management of Abdominal Pregnancy with Local Injection of Vasopressin Solution: A Case Report
Unusual or unexpected effect of treatment, Unexpected drug reaction , Rare disease
Kenji Hishikawa, Takanori Fukuda, Hiromi Inoue, Yutaka Kohata, Mika Monma, Naomi Ochiai, Yuina Kubo, Remi Watanabe, Shiho Ako, Yuri Aihara, Takeshi Kusaka
(Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan)
Am J Case Rep 2016; 17:637-640
Laparoscopic treatments of abdominal pregnancy have been reported; however, resection of an implanted gestational sac could lead to massive bleeding and treatment failure. Hemostasis of the resected stump is critical for the success of laparoscopic treatment.
CASE REPORT: A 32-year-old woman presented to the emergency department with severe abdominal pain. We suspected a ruptured ectopic pregnancy and performed urgent diagnostic laparoscopy. The gestational sac was implanted in the posterior wall of the uterus near the left uterosacral ligament, and bleeding from the gestational sac was noticed. We injected 3 ml of diluted vasopressin solution (0.4 U/ml) directly into the gestational sac and into the posterior uterine wall around the gestational sac. Thereafter, we could resect the gestational product using an ultrasonically activated scalpel. Additional hemostasis in the resected stump was not required.
CONCLUSIONS: We believe that a local injection of a diluted vasopressin solution helps in maintaining the hemostasis after the laparoscopic resection of the implanted gestational sac in cases of abdominal pregnancy.
Keywords: Hysterectomy - methods, Humans, Female, Adult, Injections, Laparoscopy - methods, Postoperative Hemorrhage - prevention & control, Pregnancy, Pregnancy, Abdominal - surgery, Vasoconstrictor Agents - administration & dosage, Vasopressins - administration & dosage