Laparoscopic management of a primary omental pregnancy after clomiphene induction

Sertaç Esin, Hilmi Yildirim, Hilmi Yıldırım, Fikret Tanzer
In: Fertility and Sterility · 2009 · vol. 92(1) , pp. 392.e1–392.e3 · doi:10.1016/j.fertnstert.2009.02.026 · PMID:19327765 · W2072717082
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This case report describes the successful laparoscopic management of a primary omental pregnancy in a 22-year-old woman, highlighting that such ectopic pregnancies may mimic adnexal masses and are effectively treated via minimally invasive surgery.

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Abstract

ObjectiveTo describe the successful laparoscopic management of a primary omental pregnancy.DesignCase report.SettingDepartment of Obstetrics and Gynecology, Dr. Sami Ulus Obstetrics, Gynecology and Children's Hospital, Ankara, Turkey.Patient(s)A 22-year-old patient with an omental pregnancy.Intervention(s)Laparoscopic partial omentectomy.Main outcome measure(s)Successful laparoscopic management of an omental pregnancy.Result(s)A 22-year-old woman presented to the emergency room with abdominal pain and vaginal spotting. She was undergoing clomiphene (CC) induction for infertility and had a positive urine pregnancy test at home. A right adnexal ectopic pregnancy was reported by ultrasonography. Due to increasing pain, laparoscopy was performed. The uterus and fallopian tubes appeared normal without any signs of pregnancy. A well-vascularized intact omental gestational sac was discovered in the right adnexal region in close proximity to the right ovary. By laparoscopy, the sac was resected with partial omentectomy. A primary omental pregnancy was confirmed by beta-hCG-positive trophoblast cells among omental fat cells.Conclusion(s)Omental pregnancy is rather difficult to identify due to localization. When in close proximity to the adnexal region, it may mimic a tubal ectopic pregnancy. Laparoscopy offers a minimally invasive method for diagnosis and therapy.

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