Background. Ectopic pregnancy is one of the leading causes of significant maternal morbidity and mortality. Abdominal surgeries increase the risk of postoperative adhesions. We here present a case of omental ectopic pregnancy in a patient with a prior history of cesarean section.Case. A 20-year-old female presented with a two-day history of crampy lower abdominal pain. Patient was hemodynamically stable with a beta HCG of 1057 mI/mL. Transvaginal ultrasound did not show an intrauterine pregnancy but revealed an ill-defined mass in the midline pelvis extending to the right of the midline. Diagnostic laparoscopy revealed large clots in the pelvis with normal uterus and adnexa. Intra-abdominal survey revealed an omental adhesion close to the right adnexa with a hematoma. Partial omentectomy was completed and the portion of the omentum with the hematoma was sent to pathology for confirmation. Final pathology confirmed the presence of chorionic villi consistent with products of conception.Conclusion. Omental ectopic pregnancy is a rare diagnosis and often missed. We recommend careful intra-abdominal survey for an ectopic pregnancy in the presence of hemoperitoneum with normal uterus and adnexa. This can be safely achieved using laparoscopy in early gestational ages when the patient is hemodynamically stable.
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机译：背景。异位妊娠是孕产妇高发病率和高死亡率的主要原因之一。腹部手术会增加术后粘连的风险。我们在此介绍一例有剖宫产病史的网膜异位妊娠患者。一名20岁女性，有两天的下腹部绞痛史。患者的血流动力学稳定，βHCG为1057 mI / mL。经阴道超声检查未显示宫腔内妊娠，但显示中线骨盆向中线右侧延伸时出现不明确的肿块。诊断性腹腔镜检查发现子宫和附件正常的骨盆中有大块血块。腹腔内检查显示网膜粘膜靠近右侧附件并伴有血肿。完成部分网膜切除术并将部分有血肿的大网膜送病理检查确认。最终病理证实绒毛膜绒毛与受孕产物一致。大网膜异位妊娠是一种罕见的诊断，常常被遗漏。对于有正常子宫和附件的腹膜出血的异位妊娠，建议进行仔细的腹腔内检查。当患者血液动力学稳定时，可以在早期妊娠期使用腹腔镜检查安全地实现这一目标。
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