TY - JOUR
T1 - Laparoscopic Management of an Invasive Mole Perforating the Uterus
AU - Grin, Leonti
AU - Namazov, Ahmed
AU - Volodarsky, Michael
AU - Anteby, Eyal
AU - Lavie, Ofer
AU - Gemer, Ofer
N1 - Publisher Copyright:
© 2016 AAGL
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Study Objective To show the possibility of conservative laparoscopic management in a case of invasive mole perforating the uterus. Design Video with explanations. Setting An invasive mole is a potentially life-threatening complication of gestational trophoblastic disease [1]. This is a case of a 24-year-old female presenting with abdominal pain and vaginal bleeding. There have been several previous reports of cases of uterine perforation by an invasive mole, all of which were managed with abdominal hysterectomy [2–7]. To our knowledge, this is the first report of an invasive mole perforation with active bleeding managed by laparoscopy without hysterectomy. Interventions Sonography revealed a large amount of fluid and a 3 × 3-cm heterogeneous lesion next to the posterior uterine wall. Her hemoglobin level dropped from 10.6 mg/dL to 8.6 mg/dL, and her β-human chorionic gonadotropin level was 19,004 mIU/mL. On laparoscopy, ∼2500 mL of hemoperitoneum was found, along with an actively bleeding bulging mass in the posterior uterine wall. This mass was dissected, and hemostasis was secured with sutures and electrocoagulation. Pathology confirmed the diagnosis of a complete mole. After surgery, the patient was treated with 5 courses of a methotrexate-folinic acid regimen. Her recovery was uneventful. Conclusion Uterine perforation by an invasive mole can be managed conservatively with laparoscopic surgery and postoperative chemotherapy. The transmural lesion will increase the risk of future uterine rupture during pregnancy in this patient.
AB - Study Objective To show the possibility of conservative laparoscopic management in a case of invasive mole perforating the uterus. Design Video with explanations. Setting An invasive mole is a potentially life-threatening complication of gestational trophoblastic disease [1]. This is a case of a 24-year-old female presenting with abdominal pain and vaginal bleeding. There have been several previous reports of cases of uterine perforation by an invasive mole, all of which were managed with abdominal hysterectomy [2–7]. To our knowledge, this is the first report of an invasive mole perforation with active bleeding managed by laparoscopy without hysterectomy. Interventions Sonography revealed a large amount of fluid and a 3 × 3-cm heterogeneous lesion next to the posterior uterine wall. Her hemoglobin level dropped from 10.6 mg/dL to 8.6 mg/dL, and her β-human chorionic gonadotropin level was 19,004 mIU/mL. On laparoscopy, ∼2500 mL of hemoperitoneum was found, along with an actively bleeding bulging mass in the posterior uterine wall. This mass was dissected, and hemostasis was secured with sutures and electrocoagulation. Pathology confirmed the diagnosis of a complete mole. After surgery, the patient was treated with 5 courses of a methotrexate-folinic acid regimen. Her recovery was uneventful. Conclusion Uterine perforation by an invasive mole can be managed conservatively with laparoscopic surgery and postoperative chemotherapy. The transmural lesion will increase the risk of future uterine rupture during pregnancy in this patient.
KW - Invasive mole
KW - Laparoscopy
KW - Uterine rupture
UR - http://www.scopus.com/inward/record.url?scp=85011035315&partnerID=8YFLogxK
U2 - 10.1016/j.jmig.2016.08.814
DO - 10.1016/j.jmig.2016.08.814
M3 - Article
C2 - 27544879
AN - SCOPUS:85011035315
SN - 1553-4650
VL - 24
SP - 199
EP - 200
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 2
ER -