Analysis of the Causes of Heterotopic Pregnancy Misdiagnosed as Appendiceal Abscess after in Vitro Fertili-zation and Embryo Transfer

TIAN Wan-guan; MENG Qing-yi

doi:10.3969/j.issn.1002-3429.2018.07.019

Abstract：Objective To investigate causes of misdiagnosis of heterotopic pregnancy ( HP) as appendiceal abscess after in vitro fertilization and embryo transfer( IVF-ET) and its countermeasures. Methods The clinical da-ta of one case of HP misdiagnosed after IVF-ET was retrospectively analyzed. Results A 31-year-old female was ad-mitted for menelipsis for 66 d with right lower abdomen pain for 2 d. She underwent IVF-ET treatment one month be-fore admission. Physical examination showed muscular tension of the right abdomen, with tenderness and rebound tenderness in the right lower quadrant. Blood tests showed the white blood cell count of 17. 81×109/L, neutrophils of 0. 948, and human chorionic gonadotropin (HCG) of 101 031 U/L. The abdominal ultrasonography suggested that a gestational sac could be seen in the uterus, with a fetal heart beat, and an uneven and low echo mass in the right lower abdomen and free fluid in the abdominal cavity. Admission diagnosis was periappendiceal abscess, early intrau-terine pregnancy and IVF-ET performed. A large number of outmoded blood clots were found by laparoscopic explora-tion of the abdominal and pelvic cavity, and the right tubal distal mass was accompanied by bleeding. The tip of the appendix was adhered tightly to the fallopian tube mass, showing a reddish black color. Partial resection of the right fallopian tube and appendectomy were performed, and the postoperative pathological diagnosis was right tubal preg-nancy and chronic appendicitis. The patient was diagnosed as HP after IVF-ET and chronic appendicitis. The patient was discharged from hospital with improved condition after 7 days. Two months later, ultrasonography revealed fetus well-being in utero. Conclusion Heterotopic pregnancy after IVF-ET is rare, and may be easily misdiagnosed be-cause of its complicated clinical manifestations. More attention should be paid to history taking and differential diag-nosis to avoid misdiagnosis.