La grossesse cornuale, aspect laparoscopique

Abstract

Cornual pregnancy is a rare form of ectopic pregnancy. It represents a 1% incidence of abnormally implanted pregnancies. It is characterized by the development of gestation in the interstitial portion of the Fallopian tube. Its main risk is the rupture of the uterine horn that could threaten mother’s vital prognosis . Our patient is a primip and primiparous 28-year old woman. She was examined in Obstetric and Gynecological Emergency Department for pelvic pain lasting for 24 hours, with 6 weeks amenorrhea. Clinical examination showed hypogastric sensitivity and hemodynamic stability. Speculum showed a closed neck of the uterus with no evidence of metrorrhagia. Serum gonadotropin (ßHCG) test strip was positive. Transvaginal ultrasound showed an empty uterus, a thickened endometrium and a right intact cornual pregnancy. The initial rate of serum ßHCG level was 2800 IU/L. It was decided to proceed with conservative treatment. The patient underwent diagnostic and therapeutic laparoscopy. During surgery, right uterine horn showed size increase,  hypervascularization, the two tubes were beautiful and thin and a corpus luteum was found on the right ovary. Examination showed normal left ovary. The patient was treated with in situ Methotrexate injection (0,5 mg/kg, 35 Mg) by a fine needle (at the level of the uterine horn) and with intramuscular injection (35 Mg). Evolution was marked by the fall of ßHCG serum rate. The patient was discharged at day 10 after admission.

Pan African Medical Journal 2016; 23