[Hemoperitoneum after XXXX of an abdominal pregnancy--reduced therapeutic options in case of delayed diagnosis].

@entity1 @entity5852 @entity548 @entity5274 @entity397 @entity490
BACKGROUND: Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious @entity1 in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management. CASE: A 30- year-old @entity1 (II-gravida, I-para) suffering for about 18 hours from "upper @entity490 " was found in somnolent and in reduced conditions by her relatives. Unconscious and with all signs of a @entity548 , she was transferred to the emergency department of the UKBF. After stabilization of circulation, a diagnostic laparoscopy has been performed with the finding of about 2000 ml of coagulated and fresh blood, but without the confirmation of a extrauterine pregnancy (EUP): the small pelvis and his organs were without any signs of EUP. The laparoscopic approach has been changed into a secondary median laparotomy. After exclusion of other reasons for a @entity548 (such as @entity397 or gastrointestinal bleeding), and the complete removal of all intraabdominal blood clots, a embryo, his placenta and the place of placental insertion has been found in the mesenterium jejuni. The surgical procedure was finished in the usual way. The postoperative healing process was uncomplicated. CONCLUSIONS: Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between @entity5274 , resp., but definitive insertion of the placenta in the distant peritoneum. In @entity1 in their reproductive age suffering from @entity548 , the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient @entity1 history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the @entity5852 of a abdominal pregnancy has to be made by open surgery.
