Diagnosis and clinical approach in primary ovarian ectopic pregnancy: A case report and review of the literature
Primer ovaryan ektopik gebelik oldukça nadir görülüp tüm dış gebeliklerin %0,5-1’ini oluşturur. İnsidansı 1/7000-40000 gebeliktir. Spontan bir siklusta hiçbir predispozan faktör olmaksızın 40 yaşında bir hastada oluşmuş bir primer ovaryan ektopik gebelik olgusu sunacağız. Hasta akut batın belirti ve bulgularıyla preşok durumda acil kliniğimize başvurdu. Transvajinal ultrasonografide 30 mm çapında kistik sol ovaryan kitle tespit edildi. Müracaatında hemoglobin seviyesi 8,4g/dl ve serum bHCG seviyesi 2548 mlU/ml idi. Acil laparotomi ve over kama rezeksiyonu uygulandı. Histopatolojik olarak alınan materyalin yapılan çoklu kesilerinde birçok alanda over dokusu içine invaze olmuş koryon villusları izlenmiştir. Bu nadir olgunun etyolojisi, ayırıcı tanısı, klinik tanısı hakkında bilgi verilerek literatür gözden geçirilmiştir.
Primer ovaryan ektopik gebelikte tanı ve klinik yaklaşımı: Bir olgu sunumu ve literatürün gözden geçirilmesi
Primary ovarian pregnancy is a rare type of extrauterine pregnancy with an incidence of 0.5-1% of all ectopic preg- nancies. The incidence ranges from 1/40000 to 1/7000 deliveries. We report a primary ovarian pregnancy in a spontaneus conception cycle in a 40-year-old woman with no predisposing factor. The patient was admitted to the emergency clinic with signs and symptoms of acute abdomen with heamoperitoneum , in a preshock state. An emergency laparotomy and wedge resection of the ovary was performed. Histopathologic examination showed chorion villi embedded in the ovarian tissue in multiple sections in different areas of the material. This is a discus- sion about this rare phenomenon, its ethiology, differential and clinical diagnosis and a review of literature.
___
- 1. Spiegelberg O. Zur Casuistik der Ovarialschwangerschaft. Arch Gynaekol 1878;13:73-6
- 2. Berek & Novak’s Gynecology, fourteenth edition, 2007:627- 8.
- 3. Raziel A, Schachter M, Mordechai E, Friedler S, Panski M, Ron-El R. Ovarian pregnancy a 12-year experience of 19 cases in one institution. Eur J Obstet & Gynecol Reprod Biology 2004;114:92-6.
- 4. Kilic N, Demir B, Arslan A, Ozaydin M. Ovarian Pregnancy: Case report. Dicle Medical Journal 2002;29: 85-9.
- 5. Seki H, Kuromaki K, Takeda S, Kinoshita K. Ovarian preg- nancy diagnosed in the third trimester: a case report. J Ob- stet Gynecol Res 1997;23:543-6.
- 6. Shahabuddin AK, Chowdhury S. Primary term ovarian preg- nancy superimposed by intrauterine pregnancy: a case re- port. J Obstet Gynecol Res 1998;24:109-14.
- 7. Belfar H, Heller K, Edelstone DI, et al. Ovarian pregnancy resulting in a surviving neonate.Ultrasound findings. J Ul- trasound Med 1991;10:465-7.
- 8. Studzinski Z, Branika D, Filipezak A, et al. Prolonged ovar- ian pregnancy: a case report. Ginekol Pol 1999;70:33-5.
- 9. Raziel A, Golan A, Pansky M, et al. Ovarian pregnancy-a report of 20 cases in one institution. Am Obstet Gynecol 1990;163:1182-5.
- 10. Shiau CS, Hsieh CL, Chang MY. Primary ovarian pregnan- cy. Int J Gynecol Obstet 2007;96:127-30.
- 11. Check JH, Chase JS. Ovarian pregnancy with contralateral corpus luteum. Am J Obstet Gynecol 1986;154:155-6.
- 12. Williams JV. Obstetrics, Ovarian Pregnancy. Appleton-Cen- tury-Crott, New York. 1903:573.
- 13. Norris CC. Primary ovarian pregnancy and the report of a case combined with intrauterine pregnancy. Surg Gynecol Obstet 1909;9:123-7.
- 14. Cacciatore B, Stenman UH, Ylostalo P. Diagnosis of ecto- pic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 UI/I(IRP). Br J Obstet.Gynecol 1990;97:904-8.
- 15. Altunyurt S, Guclu S, Kocaoglu S, Yorukoglu K. Primary ovarian pegnancy: a case report. T Klin J Gynecol Obst 2000;10:172-3.