Rare Presentation of Chorioadenoma Destruens as Acute Haemoperitoneum Mimicking Ruptured Ectopic Pregnancy

Abstract

Gestational trophoblastic neoplasms (GTN) are proliferative degenerative disorders of placental elements and include complete or partial mole (90%), invasivemole (5-8%), choriocarcinoma (1-2%) and placental site tumor (1-2%). Chorioadenoma destruens is a trophoblastic tumor, characterized by myometrial invasion through direct extension or via venous channels. We present a case of invasive mole eroding uterus and uterine vasculature, causing sudden rupture of uterus with massive haemoperitoneum mimicking ectopic pregnancy. A 20 year old G1P0 at 6 weeks gestation presented in Casualty of Kasturba Hospital complaining of severe acute onset lower abdominal pain for one hour. Clinical examination revealed shock. Sonography suggested ectopic pregnancy and immediate exploratory laparotomy was decided. On laparotomy, 2000cc of haemoperitoneum was noted. Grape like vesicles protruding through fundal perforation with profuse active bleeding was seen. Bleeding persisted despite evacuation.Step wise uterine devascularisation failed to achieve haemostasis. Total abdominal hysterectomy was performed as a life saving measure.

Uterine leiomyosarcoma mimicking chronic ruptured ectopic pregnancy

“…Ectopic pregnancy is considered to be a great mimic in gynaecology [3] and chronic ectopic pregnancy poses a challenge because of its subtle symptoms and wide range of clinical presentation. A rare case report by Sinha M. et al describes a case of chorioadenoma destruens mimicking ruptured ectopic pregnancy [4]. A case report by Sakamoto Y et al reported gestational choriocarcinoma with uterine serosal metastasis mimicking ruptured ectopic pregnancy [5].…”

Fertility-sparing uterine lesion resection in a woman with hemoperitoneum due to invasive mole: A rare case report

“…Among 78 patients with GTN in the study by Xiaoyu Wang who achieved fertility-preserving surgery, only 5 patients underwent surgery due to suspected uterine rupture [ 7 ]. There have been several previous reports of cases of uterine perforation by an invasive mole, all of which were managed with abdominal hysterectomy [ 13 ]. To our knowledge, invasive mole perforation with active bleeding management by fertility-preserving surgery without hysterectomy is rare.…”

What is your diagnosis?

“…Ectopic pregnancy is considered to be a great mimic in gynecology (3) and chronic ectopic pregnancy poses a challenge because of its subtle symptoms and wide range of clinical presentation. A rare case report by Sinha et al (4) describe a case of chorioadenoma destruens mimicking ruptured ectopic pregnancy. A case report by Sakamoto et al (5) reported gestational choriocarcinoma with uterine serosal metastasis mimicking ruptured ectopic pregnancy.…”