An intraligamentary pregnancy is an extremely rare form of ectopic
pregnancy, with only a few cases reported. We report a 20-year-old woman who
had an ongoing pregnancy at about 22 weeks gestation, consulted for recurrent
urinary retention and severe lower abdominal pain of two days duration. Pelvic
ultrasonography revealed an extrauterine gestation of 19 weeks and four days on
the left adnexal region. Exploratory laparotomy was performed that found left
intraligamentary pregnancy (unruptured) measured 20-25cm
across, attached posteriorly to the bowel (sigmoid colon) and extended to the
pouch of douglas impinging on the bladder base. Resection of ectopic pregnancy
was successfully performed, urine retention resolved, and the patient was
discharged with no postoperative complications. Early recognition of this rare
form of ectopic gestation is of considerable importance because of the risk of
a life-threatening haemorrhagic complication necessitating emergency surgical
intervention.
References
[1]
Carusi, D. (2019) Pregnancy of Unknown Location: Evaluation and Management. Seminars in Perinatology, 43, 95-100. https://doi.org/10.1053/j.semperi.2018.12.006
[2]
Cordero, D.R., Adra, A., Yasin, S. and O’Sullivan, M.J. (1994) Intraligamentary Pregnancy. Obstetrical & Gynecological Survey, 49, 206-209.
https://doi.org/10.1097/00006254-199403000-00026
[3]
Ameer, M.A., Fagan, S.E., Sosa-Stanley, J.N. and Peterson, D.C. (2021) Anatomy, Abdomen and Pelvis, Uterus. http://www.ncbi.nlm.nih.gov/pubmed/29262069
[4]
Ade-Ojo, I.P., Akintayo, A.A., Afolayan, J.M., Aduloju, O.P. and Olagbuji, B.N. (2016) Intraligamentary Extrauterine Pregnancy Delivered at Term: A Case Report and Review of Literature. African Journal of Reproductive Health, 20, 104-108.
https://doi.org/10.29063/ajrh2016/v20i1.11
[5]
Gao, J., Liu, L., Fang, J. and Wang, Y. (2021) Broad Ligament Pregnancy: A Case Series and Literature Review. Journal of Obstetrics and Gynaecology Research, 47, 442-445. https://doi.org/10.1111/jog.14564
[6]
Suzuki, S., Takahashi, T., Ota, K., Nishimura, K., Fukase, M., Watanabe, N., et al. (2019) Successful Laparoscopic Treatment of an Abdominal Pregnancy Implanted in the Utero-Ovarian Ligament: A Case Report of a Rare Form of Ectopic Pregnancy. Journal of Obstetrics and Gynaecology, 39, 579-580.
https://doi.org/10.1080/01443615.2018.1534816
[7]
Rokhgireh, S., Gorginzadeh, M., Mehdizadehkashi, A., Tahermanesh, K. and Alizadeh, S. (2021) Broad Ligament Pregnancy in the Presence of an Intrauterine Contraceptive Device: A Case Report. International Journal of Surgery Case Reports, 79, 421-423. https://doi.org/10.1016/j.ijscr.2021.01.080
[8]
Poole, A., Haas, D. and Magann, E.F. (2012) Early Abdominal Ectopic Pregnancies: A Systematic Review of the Literature. Gynecologic and Obstetric Investigation, 74, 249-260. https://doi.org/10.1159/000342997
[9]
Vierhout, M.E. and Wallenburg, H.C. (1985) Intraligamentary Pregnancy Resulting in a Live Infant. American Journal of Obstetrics & Gynecology, 152, 878-879.
https://doi.org/10.1016/S0002-9378(85)80081-8
[10]
Chouinard, M., Mayrand, M.-H., Ayoub, A., Healy-Profitós, J. and Auger, N. (2019) Ectopic Pregnancy and Outcomes of Future Intrauterine Pregnancy. Fertility and Sterility, 112, 112-119. https://doi.org/10.1016/j.fertnstert.2019.03.019
[11]
Audifred Salomón, J.R., Herrera Ortiz, A., González Medrano, M.G. and Estrada Rivera, S.F. (2013) Ectopic Intraligamentary Pregnancy. Revista de Ginecología y Obstetricia de México, 81, 211-214.
[12]
Azhar, E., Green, L., Mohammadi, S. and Waheed, A. (2020) Ruptured Right Broad Ligament Ectopic Pregnancy in a Patient with Prior Right Salpingo-Oophorectomy: A Case Report. Cureus, 12, Article No. e8276. https://doi.org/10.7759/cureus.8276
[13]
Asah-Opoku, K., Oppong, S.A., Ameme, D.K., Nuamah, M.A., Mumuni, K., Yeboah, A.O., et al. (2019) Risk factors for Ectopic Pregnancy among Pregnant Women Attending a Tertiary Healthcare Facility in Accra, Ghana. International Journal of Gynecology & Obstetrics, 147, 120-125. https://doi.org/10.1002/ijgo.12928
[14]
Rudra, S., Gupta, S., Taneja, B.K. and Garg, M. (2013) Full-Term Broad Ligament Pregnancy. Case Reports, 2013, Article ID: bcr2013010329.
https://doi.org/10.1136/bcr-2013-010329
[15]
Kirk, E. (2012) Ultrasound in the Diagnosis of Ectopic Pregnancy. Clinical Obstetrics and Gynecology, 55, 395-401. https://doi.org/10.1097/GRF.0b013e31824e35fe
[16]
Sassi, A., Dimassi, K., Ben Slama, S., Triki, A. and Lahmar, A. (2018) A Broad Ligament Pregnancy Successfully Managed by Laparoscopy. Journal of Obstetrics and Gynaecology, 38, 423-424. https://doi.org/10.1080/01443615.2017.1342231