Resumen
Introducción: el embarazo ectópico abdominal es una complicación poco frecuente con elevada morbimortalidad materna y perinatal. El objetivo fue presentar el manejo multidisciplinario de un embarazo ectópico abdominal avanzado asociado a COVID-19 y hacer una revisión de la literatura.
Caso clínico: paciente multigesta de 33 años, con embarazo ectópico abdominal de 34 semanas, diagnosticado por ultrasonido a las 27 semanas. Seis días antes inició con dolor abdominal difuso. Fue referida con prueba RT-PCR para SARS-CoV-2 positiva, sin síntomas respiratorios. La tomografía reportó probable infiltración a asas intestinales, techo vesical y uretero derecho. El ultrasonido abdominal corroboró diagnóstico y mostró ausencia de compromiso de vasos iliacos y ureteros. La resonancia magnética reportó aporte vascular del lecho placentario dependiente de arteria iliaca derecha y ramos distales de mesentérica superior. Se hizo laparotomía exploradora y se encontró al feto vivo en cavidad abdominal con amnios roto, peso 2385 gramos, Apgar 5/8; placenta con implantación en ligamento ancho, salpinge, ovario, techo vesical, ligamento infundibulopélvico y apéndice. Se realizó histerectomía total abdominal con salpingooforectomía derecha, salpingectomía izquierda y apendicectomía. Hubo un sangrado total de 3000 mL y una evolución postquirúrgica favorable.
Conclusión: el embarazo ectópico abdominal representa un reto en la obstetricia. Ofrecer un manejo multidisciplinario permite tener un resultado favorable.
Abstract
Background: Abdominal ectopic pregnancy is a rare complication with high maternal and perinatal morbimortality. The objective was to present the multidisciplinary management of an advanced abdominal ectopic pregnancy associated with COVID-19, and a review of the literature.
Clinical case: 33-year-old multiparous patient with an abdominal ectopic pregnancy of 34 weeks, diagnosed by ultrasound at 27 weeks. 6 days prior to admission she started with diffuse abdominal pain. She was referred with positive RT-PCR test for SARS-CoV-2, without respiratory symptoms. CT scan reported probable infiltration of bowel loops, bladder roof and right ureter. Abdominal ultrasound corroborated the diagnosis and showed absence of involvement of iliac and ureteral vessels. MRI reported vascular contribution of the placental bed dependent on the right iliac artery and distal branches of the superior mesenteric artery. Exploratory laparotomy was performed, finding a live fetus in the abdominal cavity with a ruptured amnion, weight 2385 g, Apgar 5/8; placenta with implantation in the broad ligament, salpinges, ovary, bladder roof, infundibulopelvic ligament and appendix. A total abdominal hysterectomy was performed with right salpingo-oophorectomy, left salpingectomy and appendectomy. The total bleeding was of 3000 mL and there was a favorable post-surgical evolution.
Conclusion: Abdominal ectopic pregnancy represents a challenge in obstetrics. Offering a multidisciplinary management allows to have a favorable outcome.
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