Fig. 6.1
Bleeding tubal ectopic pregnancy with hemoperitoneum. (Courtesy of Dr. Togas Tulandi)
Fig. 6.2
Injecting dilute vasopressin solution into an adherent and bleeding ectopic pregnancy
Fig. 6.3
Adhesiolysis of ectopic pregnancy to ovary and pelvic sidewall led to even more bleeding
Fig. 6.4
Continued bleeding and abnormal tubal anatomy that could not be salvaged led to the final decision to perform salpingectomy
Outcome
The patient underwent laparoscopy . The ectopic was clearly identified and the remainder of her tube appeared normal. Therefore, salpingostomy with excision of the ectopic pregnancy was performed but this was complicated by brisk bleeding. Pressure and bipolar cautery were applied with unsatisfactory result. The bleeding was too brisk for hemostatic agents and interrupted, 6–0 polyglactic sutures were placed. Pneumoperitoneum was then decreased and slow, bright red oozing was noted from a sutured area. Therefore, a thrombin matrix hemostatic agent was applied. The area was reinspected and was confirmed to be hemostatic. The patient recovered uneventfully and her serum beta-hCG was followed to undetectable levels.