Tubární potrat představuje vypuzení plodu z vejcovodu do dutiny břišní. Může být kompletní nebo nekompletní s rezidui přetrvávajícími ve vejcovodu. Jedná se o formu mimoděložního těhotenství, jejíž incidenci nelze přesně stanovit. Rozpoznání případů tubárního abortu je zásadní v péči o pacientku, protože může vést ke konzervativnějšímu přístupu. Diagnóza by měla být stanovena kombinací ultrazvukového vyšetření, hladiny b-hCG a peroperačního nálezu. Článek popisuje případ 30leté pacientky přijaté pro suspektní mimoděložní graviditu, kdy ultrazvukové vyšetření prokázalo masu připomínající tubární graviditu vedle dělohy a hladiny b-hCG byly 111,8 U/l. Peroperačně byl zjištěn tubární abort v Douglasově prostoru umožňující zachování obou vejcovodů. Histopatologický rozbor potvrdil klinickou diagnózu. Konzervativní přístup může mít dostatečný efekt v případě tubárního abortu, což umožňuje zachování fertility a tubárních funkcí.
Tubal abortion is characterized by the extrusion of the foetus into the abdominal (peritoneal) cavity. It can either be a complete extrusion or incomplete with residual tissue remaining in the fallopian tube. It is a type of ectopic pregnancy that is difficult to determine the exact incidence of tubal pregnancies. Identifying cases of tubal abortions is crucial for individualized care since it can lead to a more conservative treatment approach. The diagnosis should be based on ultrasound imaging, b-hCG levels and visual conformation during exploratory surgery, either open or laparoscopic. The article describes the case of a 30-year old patient who presented with lower abdominal pain and was admitted for a suspected ectopic pregnancy. Ultrasound imaging showed a mass resembling a tubal pregnancy next to the uterus with b-hCG levels of 111.8 U/L. During laparoscopic surgery, a tubal abortion was detected in the pouch of Douglas (Rectouterine pouch). This finding led us to preserve both fallopian tubes. Histopathology confirmed our clinical findings. A conservative approach can be sufficient in case of tubal abortions, which can lead to preserved fertility and tubal functions.
- MeSH
- Adult MeSH
- Douglas' Pouch diagnostic imaging pathology MeSH
- Gynecologic Surgical Procedures methods MeSH
- Laparoscopy MeSH
- Humans MeSH
- Chorionic Gonadotropin, beta Subunit, Human analysis MeSH
- Pregnancy, Ectopic * surgery diagnostic imaging pathology MeSH
- Salpingectomy MeSH
- Abortion, Spontaneous * surgery diagnostic imaging pathology MeSH
- Pregnancy MeSH
- Ultrasonography MeSH
- Uterus diagnostic imaging pathology MeSH
- Fallopian Tubes surgery diagnostic imaging pathology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Arterial branches to the uterus and ovaries that pass through the mesosalpinx contribute significantly to the maintenance of the ovarian reserve. Especially arterial supply of the uterine tube is provided by a number of anastomoses between both the uterine and ovarian vessels. Knowledge on the morphologic peculiarities will allow to identify main contributors especially blood flow ultrasound examination for the purpose of ovary preserving surgery. This study aimed at identifying landmarks especially for so-called low-flow tubal vessels. Arteries of 17 female Thiel-embalmed bodies were studied along three preselected paramedian segments and measurements taken. A section was made through the center of the ovary perpendicular to uterine tube, then the mesosalpinx tissue distance was divided into 3 equivalent zones: upper, middle and lower thirds. The surface area of the mesosalpinx averaged 1088 ± 62 mm2. 47.7 ± 7.1 % of the mesosalpinx zones included macroscopically visible vessels. The lower third segment of mesosalpinx was the thickest averaging 2.4 ± 1.5 mm. One to three tubal branches were identified in the middle third of the mesosalpinx. Arterial anastomoses were found in the upper segment of the mesosalpinx, but no presence of a marginal vessel supplying the fallopian tube could be found. Statistically significant moderate positive correlations were established between the diameters of the mesosalpingeal arteries between the three zones. The mesosalpinx, uterine tube and the ovary form areas of segmental blood supply. Variants of tubal vessels appear to be a sparse source of blood supply.
