A case of peritoneal pregnancy on the pouch of Douglas: Laparoscopic removal of the gestational sac using a reusable surgical probe for the rectum

Abstract

Peritoneal pregnancy is relatively rare and accounts for approximately 1% of all ectopic pregnancies. Accurately diagnosing peritoneal pregnancy before surgery is difficult; thus, gynecologists may encounter the disease accidentally. Many studies have reported that peritoneal pregnancy is preoperatively diagnosed as tubal pregnancy. The implantation sites varied in each case. In some cases, the implantation sites can be close to other organs such as the rectum, ureter, and bladder. Thus, it is important for operators to take measures to not injure the organs. Here, we report a case of peritoneal pregnancy implanted on the pouch of Douglas inside of the right uterosacral ligament. The gestational sac did not develop in the abdominal space but developed in the retroperitoneal space; thus, it should have been near the rectum. When laparoscopy was initiated, the positional relationship between the rectum and gestational sac was unclear. We inserted a reusable surgical probe (Rectal Sonde ® ) into the rectum and moved it slowly and carefully and assessed the positional relationship. We safely removed the gestational sac. A reusable surgical probe for the rectum has been reported to be useful for laparoscopic adhesiolysis of the posterior cul-de-sac obliteration associated with endometriosis. We reported the usefulness of the probe in laparoscopic surgery to remove ectopic gestational sacs near the rectum.