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Background: Extrauterine ectopic pregnancy is a rare form of ectopic pregnancy, accounting for roughly 1:10,000–30,000 of all pregnancies. Primary omental pregnancy is the least common form of abdominal ectopic pregnancies, making it extremely rare. Typical presentation includes pelvic pain, secondary amenorrhea, with or without vaginal bleeding. Atypical presentations range from nonspecific pain to asymptomatic. Case: A 19-year-old woman presented to the emergency department after several syncopal episodes. She had a positive urine pregnancy test (serum hCG 446 IU/L). Her hemoglobin level was 10.6 g/dL. Due to lack of pain or bleeding, abdominal imaging was not indicated. A head CT scan rendered negative results. She was subsequently diagnosed with idiopathic headaches and anemia and was discharged. She returned to hospital 48 h later with vaginal bleeding and additional syncopal episodes. She was not experiencing any abdominal pain or discomfort. Her anemia worsened (hemoglobin 7.5 g/dL). For this reason, imaging was performed. It was significant for massive hemoperitoneum. Due to the imaging findings and worsening anemia, diagnostic exploratory laparoscopy was recommended to evaluate for ruptured ectopic pregnancy. Laparoscopic findings revealed large hemoperitoneum and a 10-week gestational sac attached to the greater omentum near the transverse colon. This exceedingly rare presentation of extrauterine ectopic pregnancy offered few clinical clues other than worsening anemia until imaging later revealed the abnormality. Ruptured ectopic pregnancy, a potentially fatal complication of pregnancy, should be included into the differential diagnosis of any gravid patient with syncope and anemia unexplained by extensive diagnostic workup.

Ectopic pregnancy, the implantation of a fertilized ovum outside theendometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman. A 24 year-old woman gravid 1, para 0, with lower abdominal pain. Her last menstrual period occurred 8 weeks before the visit. The physical examination revealed abdominal tenderness in the lower quadrants, she was not bleeding. Transvaginal ultrasound showed: a free anechoic/hypoechoic area of 30 x 57 mm in the pouch of Douglas and the endometrium was homogeneus with a thickness of 12 mm and no evidence of gestational sac in the uterine cavity. Laboratory data revealed a normal cell blood count and beta hcg levels of 8047 IU / L. Because of continuing abdominal pain and a diagnosis of ectopic pregnancy a diagnostic laparoscopy was performed, which showed hemoperitoneum. Further inspection of abdominal cavity revealed a bloody lesion that was tenaciously adherent to the omentum, using non traumatic laparoscopic forceps and bipolar scissors we carefully removed a friable mass of about 30 mm from the omental attachments. Histological examination showed the presence of blood clot material mixed with trophoblastic tissue. Ultrasound evaluation and andhCG assessment are important to determine the extrauterine location of the ectopic pregnancy but the early diagnosis of abdominal pregnancy requires also a laparoscopic evaluation and , as our case has highlighted, thorough abdominal exploration especially in the absence of adnexal findings when ectopic pregnancy is highly suspected. Early diagnosis of omental pregnancy is difficult but essential to reduce the high mortality risk for the mother.

pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman. A 24 year-old woman gravid 1, para 0, with lower abdominal pain. Her last menstrual period occurred 8 weeks before the visit. The physical examination revealed abdominal tenderness in the lower quadrants, she was not bleeding. Transvaginal ultrasound showed: a free anechoic/hypoechoic area of 30 x 57 mm in the pouch of Douglas and the endometrium was homogeneus with a thickness of 12 mm and no evidence of gestational sac in the uterine cavity. Laboratory data revealed a normal cell blood count and beta hcg levels of 8047 IU / L. Because of continuing abdominal pain and a diagnosis of ectopic pregnancy a diagnostic laparoscopy was performed, which showed hemoperitoneum. Further inspection of abdominal cavity revealed a bloody lesion that was tenaciously adherent to the omentum, using non traumatic laparoscopic forceps and bipolar scissors we carefully removed a friable mass of about 30 mm from the omental attachments. Histological examination showed the presence of blood clot material mixed with trophoblastic tissue. Ultrasound evaluation and and hCG assessment are important to determine the extrauterine location of the ectopic pregnancy but the early diagnosis of abdominal pregnancy requires also a laparoscopic evaluation and, as our case has highlighted, thorough abdominal exploration especially in the absence of adnexal findings when ectopic pregnancy is highly suspected. Early diagnosis of omental pregnancy is difficult but essential to reduce the high mortality risk for the mother. [ABSTRACT FROM AUTHOR]

Abstract: Omental pregnancy is a very rare form of abdominal pregnancy, and can be life threatening in cases of rupture, which may lead to massive hemorrhage. A 28-year-old woman in the ninth week of amenorrhea had severe abdominal pain, and showed unstable vital signs caused by intraperitoneal hemorrhage. Emergency laparoscopy revealed large amounts of blood and blood clots in abdominal cavity, and active bleeding was observed from the right ovary. Uterus, left ovary, and bilateral fallopian tubes were grossly free. However, serum β-human chorionic gonadotropin level increased after the operation, and histopathologic results did not show evidence of pregnancy in either right ovary or endometrium. Abdominal magnetic resonance imaging was performed and revealed a well-defined cystic mass at the lateral side of the ascending colon, suggested to be the focus of ectopic pregnancy. The patient was approached laparoscopically and consequently underwent partial omentectomy. [Copyright &y& Elsevier]

Omental pregnancy is an extremely rare type of ectopic pregnancy. We present a case in which a 26-year-old woman was admitted to the emergency room with abdominal pain. She was diagnosed with a ruptured ectopic pregnancy after a positive urinary pregnancy test and transvaginal ultrasound. Laparoscopic surgery showed intact pelvic organs and an ectopic mass on the omentum. The patient was treated successfully with laparoscopic partial omentectomy, and pathologic examination confirmed an omental pregnancy. As evidenced by this case, laparoscopy can be useful to diagnose and treat unusually located ectopic pregnancies. [ABSTRACT FROM AUTHOR]

Omenta pregnancy is an uncommon form of abdominal pregnancy; it has never been previously reported after IVF. A 35-year-old patient underwent IVF for tubal factor infertility. The treatment cycle was uneventful, but 3 weeks following embryo transfer the patient was diagnosed with a right tubal ectopic pregnancy on ultrasound. A laparoscopic salpingectomy was performed and the patient was discharged home. Two weeks later, the patient presented with abdominal pain and rising serum β-human chorionic gonadotrophin (β-HCG). A repeat laparoscopy showed omental and peritoneal trophoblastic implants. These were excised laparoscopically and confirmed on histology to be trophoblastic tissue. The HCG returned to <3 IU/l, 1 week post-operatively. This case emphasizes the importance of intra-operative care during laparoscopic surgery for ectopic pregnancy and the need for post-operative surveillance of serum β-HCG. An abdominal pregnancy, though rare, has a seven times higher mortality rate than non-abdominal pregnancies. Early diagnosis and treatment can prevent intra-abdominal haemorrhage, as haemorrhagic shock is the commonest cause of mortality from omental pregnancy. [ABSTRACT FROM AUTHOR]

Omental pregnancy is a very rare form of ectopic pregnancy. A 29-year-old woman presented with severe abdominal pain. History of the patient revealed use of combined oral contraceptive pills. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; gestational sac was detected attached to the necrotic lower edge of omentum. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexal involvement. [ABSTRACT FROM AUTHOR]

Abstract: Abdominal pregnancy is a rare and serious type of extrauterine pregnancy that is estimated to be approximately 1% to 4% of all ectopic pregnancies with omental pregnancy is the least common. An incidental case of a primary omental pregnancy was treated by laparoscopic partial omentectomy. The aim of this presentation is to keep in mind that pregnancy can exist in unusual locations, so a thorough inspection of the abdominal cavity is imperative. [Copyright &y& Elsevier]

Omental pregnancy is an extremely rare form of abdominal pregnancy. Only 16 cases had been reported in the literature, and most were secondary omental pregnancies. We presented a case of primary omental pregnancy located on "gastrocolic ligament" diagnosed at surgical operation. The aim of this presentation is to remember that pregnancy can exist in unusual localizations, so abdominal observation and examination is very important during operations. [ABSTRACT FROM AUTHOR]

Discusses the complications of an omental pregnancy in a woman under a progestogen-only pill medication. Diagnosis of ectopic pregnancy with complex ovarian cyst; Laparotomic surgery.

Objective: To describe the successful laparoscopic management of a primary omental pregnancy. Design: Case report. Setting: Department of Obstetrics and Gynecology, Dr. Sami Ulus Obstetrics, Gynecology and Children''s Hospital, Ankara, Turkey. Patient(s): A 22-year-old patient with an omental pregnancy. Intervention(s): Laparoscopic partial omentectomy. Main Outcome Measure(s): Successful laparoscopic management of an omental pregnancy. Result(s): A 22-year-old woman presented to the emergency room with abdominal pain and vaginal spotting. She was undergoing clomiphene (CC) induction for infertility and had a positive urine pregnancy test at home. A right adnexal ectopic pregnancy was reported by ultrasonography. Due to increasing pain, laparoscopy was performed. The uterus and fallopian tubes appeared normal without any signs of pregnancy. A well-vascularized intact omental gestational sac was discovered in the right adnexal region in close proximity to the right ovary. By laparoscopy, the sac was resected with partial omentectomy. A primary omental pregnancy was confirmed by β-hCG-positive trophoblast cells among omental fat cells. Conclusion(s): Omental pregnancy is rather difficult to identify due to localization. When in close proximity to the adnexal region, it may mimic a tubal ectopic pregnancy. Laparoscopy offers a minimally invasive method for diagnosis and therapy. [Copyright &y& Elsevier]