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Left Tubal bleeding ectopic gestation: Laparoscopic management
Ectopic gestation still represents a medical emergency
Symptoms can be typical of an acute abdomen, but in some cases such as this, presentation can be less typical.
A 32 year old mother of one, complained of general abdominal pain and PV bleeding for two days
She thought this coincided with her period since her last menstruation had occurred 28 days before.
She had similar pains before,,, but this time she felt also nausea, bloated abdomen and breast tenderness.
A B-HCG blood test showed 2650 U/L and on vaginal US she was tender with a small amount of free fluid in the pouch of Douglas.
The uterine cavity was empty and there was a longitudinal mass near the left ovary without an obvious fatal pole.
She was consented for an emergency laparoscopy with the diagnosis of left ectopic gestation
After inserting the laparoscope a small amount of blood, mostly old, was seen in the pelvis.
There was not active bleeding.
The blood was carefully washed and the pelvic organs cleaned and assessed.
It became obvious that the patient had an unraptured left ectopic gestation in her terminal isthmic portion of her left Fallopian tube.
The right tube was carefully assessed too, and was found healthy as well as both ovaries.
It was decided to excise the Fallopian tube with the ectopic pregnancy
The operation started by grasping the isthmus of the tube and cauterising with bipolar diathermy
The isthmus was cut
The operation proceeded cephalad, along the mesosalpinx, keeping as close to the tube as possible
Finally the tubal ligament with the blood supply were cauterised and cut
The whole tube with the ectopic were excised, placed in a laparoscopic bag and removed
The pelvis was cleaned again and checked for homeostasis
Remember ectopic pregnancies can manifest themselves in a variety of ways
Symptoms are not always typical and women confuse menstruation with early pregnancy implantation bleeding!
Always exclude an ectopic pregnancy
Do not rely on symptoms alone!
The most important tests are a B-HCG combined with vaginal sonography
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