Pregnancy-Preserving Laparoscopic Treatment of Acute Hemoperitoneum Following Lutein Cyst Rupture in Early Gestation

Abstract

Acute hemoperitoneum (AHP) in early gestation is commonly treated via laparotomy. A ruptured corpus luteum (CL) cyst is a rare cause of AHP in pregnancy. This case report describes a 33-year-old, hemodynamically stable G2/P1 who presented at 5+5 gestational weeks with an acute abdomen due to ruptured CL cyst (7 cm). Emergent laparoscopy was performed. After evacuation of 1 L of hemoperitoneum, an atraumatic hemostasis was obtained without diathermy by use of hemostatic matrix (Floseal^®). The ovary was reformed with an absorbable suture under preservation of CL. The postoperative recovery was uncomplicated. The hemoglobin drop was 2.8 g/dl. Further pregnancy course was uneventful. A healthy baby (2860 g) was delivered vaginally at 38+3 weeks of gestation.

Conclusion Laparoscopic approach to AHP in early pregnancy is suitable. CL preservation is feasible by use of atraumatic hemostatics.

Zusammenfassung

Hintergrund Die Blutstillung beim akuten Hämoperitoneum (AHP) in der (Früh)schwangerschaft erfolgt oft durch Laparotomie. Eine rupturierte Corpus luteum (CL) Zyste ist eine seltene Ursache des AHP in graviditate.

Fallbericht Eine 33-jährige, hämodynamisch stabile Patientin (G2/P1) stellte sich mit einem akuten Abdomen in der 5+5 SSW vor. Eine Notfall-Laparoskopie ergab als Ursache des massiven Hämoperitoneums eine rupturierte CL Zyste (7 cm) links. Nach Evakuation von 1 L Blut und Koageln erfolgte eine atraumatische Hämostase mit Erhalt des CL. Auf Verwendung thermischer Energie konnte verzichtet werden. Die spannungsfrei angelegte Naht diente lediglich der Adaptation der Wundränder. Der postoperative Verlauf war unauffällig. Der Hb-Abfall betrug 2.8 g/dl. Nach komplikationslosem weiterem Schwangerschaftsverlauf erfolgte eine Spontangeburt in der 38+3 SSW mit Entbindung eines gesunden Mädchens (2860g).

Schlussfolgerung Auch in der (Früh)schwangerschaft ist der laparoskopische Zugang möglich und mit wenig Morbidität verbunden. Eine atraumatische Hämostase ist die Voraussetzung für den CL-Erhalt.

Key words

laparoscopy - hemoperitoneum - early pregnancy - corpus luteum cyst - hemostatic matrix

Schlüsselwörter

Laparoskopie - Hämoperitoneum - Frühgravidität - Corpus luteum Zyste - Hämostatische Matrix

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