Korean J Obstet Gynecol KJOG Korean Journal of Obstetrics & Gynecology 2233-5188 2233-5196 Korean Society of Obstetrics and Gynecology 10.5468/KJOG.2011.54.12.812 Case Report Successful management of abdominal pregnancy implanted on posterior cul-de-sac with postoperative selective transcatheter artery embolization: A case report Kim Young-Ran MD 1 Jeon Gyeong-Sik MD 2 Jeong Young-Ju MD 3 Lee Jeong-Heon MD 3 Cho Dong-Hyu MD 3 Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea. Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea. Department of Obstetrics and Gynecology, Chonbuk National University Medical School, Jeonju, Korea. Corresponding author: Dong-Hyu Cho, MD. Department of Obstetrics and Gynecology, Chonbuk National University Medical School, 634-18 Geumam-dong, Deokjin-gu, Jeonju 561-712, Korea. Tel: +82-63-250-1360, Fax: +82-63-254-4833, obgyn2001@hanmail.net 12 2011 15 12 2011 54 12 812 816 01 08 2011 23 09 2011 13 10 2011 Copyright © 2011. Korean Society of Obstetrics and Gynecology 2011

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Primary abdominal pregnancy with implantation on the posterior cul-de-sac area is a very rare form of ectopic pregnancy that involves nonspecific clinical symptoms and physical findings, making early diagnosis very difficult. Whereas diagnostic laparoscopy can be performed in suspicious of abdominal pregnancy for accurate diagnosis and treatment, complete ligation of the vessel supplying blood to the placenta during surgery is often difficult. In many cases, there is continuous massive hemorrhage after litigation, significantly increasing maternal morbidity and mortality. We herein report with literature references a case of a 33-year-old female patient of primary abdominal pregnancy with implantation on the posterior cul-de-sac area. She showed hemostatic failure in a blood vessel after undergoing a surgery to remove the gestational sac, and was successfully treated with additional transcatheter arterial embolization.

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Laparoscopic operation findings (A) Hematoma and blood clots are noted in pelvic cavity. (B) Left salpinx shows normal appearance with Lt. dermoid cyst. (C) Right adnexa shows normal appearance. (D) About 3 × 4 cm sized cystic mass was noted on posterior cul-de-sac (white arrow).

(A) Right inferior epigastric artery angiogram showed contrast extravasation (black arrow). (B) To protect the distal portion of inferior epigastric artery, embolization was done.