腹腔鏡下手術後に一過性の水腎症を発症した卵管間質部双胎妊娠の1例

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  • Interstitial Twin Pregnancy Followed by Transient Unilateral Hydronephrosis after Laparoscopic Surgery

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  Interstitial pregnancy has increased in prevalence, and accounts for 2% to 4% of all tubal pregnancies. The actual rate of occurrence of interstitial twin pregnancy is unknown because of the rarity of this condition. Here, we report an interstitial twin pregnancy that was treated using laparoscopy; to the best of our knowledge, this is the third report of such a case. A 36-year-old woman with a 6-week history of amenorrhea underwent dilatation and curettage because of a suspected spontaneous abortion; chorionic villi were not found in the uterine contents. Transvaginal ultrasonography performed 9 days later showed an empty uterus with a thin endometrium and a single gestational sac containing 2 viable embryos with growth corresponding to the eighth gestational week in the right interstitial area. The patient was clinically diagnosed with an interstitial twin pregnancy and underwent emergency laparoscopic surgery. Extensive membranous adhesions involving both adnexa were found. After an adhesiotomy was performed, the right cornu was seen to be dilated to approximately 5 cm in diameter, with surface hyperemia and no signs of rupture. Vasopressin was injected into the myometrium, and a right cornual resection and salpingectomy were performed. Both ovaries remained adherent in the retroperitoneum. To prevent persistence of the ectopic pregnancy, the patient was administered methotrexate, and the urine level of human chorionic gonadotropin decreased to normal 4 weeks after surgery. However, at that time she began to complain of dull back pain. Computed tomography revealed a cystic lesion (diameter, approximately 5 cm) in the right ovary, and dilatation of the right renal pelvis and ureter. The size of the follicular cyst decreased when the patient began menstruating, and the right hydronephrosis improved 8 weeks after surgery. In conclusion, in patients with extensive pelvic adhesions involving the ovaries, an obstructed urinary tract may be the result of ovarian swelling. Therefore, it is important to be aware of adhesions involving the ovaries and the location of the ovaries in relation to the urinary tract.

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