Heterotopic pregnancy after surgical treatment of colorectal endometriosis

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Background: The ovaries and pelvic peritoneum, fallopian tubes, intestines, bladder, cervix and vagina are the most common sites of endometrioid lesions. The preservation and restoration of fertility in patients with endometriosis represent a significant and frequently discussed issue.

Case report: The report presents a clinical observation of spontaneous heterotopic pregnancy with one gestational sac implanted in the uterine cavity and the second gestational sac implanted in an adhesion conglomerate in the area of endometrioid heterotopias that formed an infiltrative focus. The article describes the characteristics of ultrasound diagnosis and operative management of the patient with two embryos located outside and inside the uterine cavity. It also demonstrates the interaction of the departments in the medical institution and the significance of diagnostic intraoperative ultrasound guidance. All timely interventions enabled the possibility of prolonging the uterine pregnancy. The patient gave birth at term.

Conclusion: The clinical observation demonstrated the diagnostic capabilities of scanning with the 3D reconstruction technology, the use of endocavitary transducers in case of heterotopic pregnancy and intraoperative ultrasound guidance. The patient’s adherence to treatment, modern diagnostic and treatment technologies, doctors’ professionalism ensured the preservation of the woman’s reproductive health.

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作者简介

Lyudmila Kondratovich

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

编辑信件的主要联系方式.
Email: l_kondratovich@oparina4.ru
ORCID iD: 0000-0003-4717-4019

PhD, Obstetrician-Gynecologist at the Surgical Department

俄罗斯联邦, Moscow

Vyacheslav Chursin

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_chursin@oparina4.ru
ORCID iD: 0009-0002-9952-6629

Surgeon at the Surgical Department

俄罗斯联邦, Moscow

Alan Dzhabiev

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_dzhabiev@oparina4.ru
ORCID iD: 0000-0002-2858-0129

Doctor at the Department of Ultrasound Diagnostics

俄罗斯联邦, Moscow

Vladimir Chuprynin

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_chuprynin@oparina4.ru
ORCID iD: 0009-0003-7856-2863

PhD, Head of the Surgical Department

俄罗斯联邦, Moscow

Alina Badlaeva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: l_kondratovich@oparina4.ru
ORCID iD: 0000-0001-5223-9767

PhD, Pathologist, Senior Researcher at the Pathological Department No. 1

俄罗斯联邦, Moscow

参考

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2. Fig. 1. MRI picture of endometrioid cysts of both ovaries, presence of pelvic fibre endometriosis foci with involvement of the intestinal wall (in fronatal projection)

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3. Fig. 2. MRI picture of endometrioid cysts of both ovaries, presence of pelvic fibre endometriosis foci with involvement of the intestinal wall (in sagittal projection)

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4. Fig. 3. Videocolonoscopy. Narrowing of the rectal lumen at the level of 12 cm from the anus

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5. Fig. 4. Echogram of the pelvic organs. Thickening and heterogeneity of fallopian tubes

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6. Fig. 5. Intraoperatively. Retrocervical endometriosis

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7. Fig. 6. Macro preparation. Resected part of the colon

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8. Fig. 7. Macro preparation. Resected part of the colon, on the section

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9. Fig. 8. Fragment of the operation. The ampullary section of the left fallopian tube is soldered to the intestine, the sigmoid colon is soldered to the posterior surface of the uterus and the left pelvic wall with loose fusions

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10. Fig. 9. Fragment of the operation. The ampullary section of the left fallopian tube is adhered to the intestine, the sigmoid colon is adhered to the posterior surface of the uterus and the left pelvic wall with loose fusions

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11. Fig. 10. Fragment of the operation. Extraction of the fallopian tube from the adhesion conglomerate

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12. Fig. 11. Intraoperative echogram. Presence of chorion in the adhesion conglomerate

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13. Fig. 12. Fragment of the operation. Choroidal tissues

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14. Fig. 13. Micro specimen. Foci of endometrioid heterotopia in the wall of the left fallopian tube. Number 1 indicates the fallopian tube lumen, number 2 - endometrioid heterotopia with decidual reaction in the stroma. The green arrow indicates the stromal component of the heterotopia, and the red arrow indicates the glandular component. The upper two photos were taken at magnification x40, the middle one - x100, the lower one - x200. The preparations were stained with haematoxylin and eosin

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