Patient L.P. A (40 years old, Hai Duong) was admitted to the hospital in a state of prolonged abdominal pain for two weeks but the cause has not been determined. Notably, blood tests showed pregnancy, but many ultrasounds, including transvaginal ultrasounds at some medical facilities before, did not detect the gestational sac in the uterus or aside. This made doctors suspect that the fetus implanted in an abnormal location.
One day before being admitted to the hospital, the patient's abdominal pain suddenly increased sharply, spreading down to the lower abdomen and lower back. Faced with abnormal developments, the doctors expanded their approach, prescribed abdominal ultrasound and discovered a large gestational mass, accompanied by blood clots around.
What the team is particularly concerned about is not only the size or amount of blood clots, but also because the gestational mass is located in an extremely dangerous position: right in front of the abdominal aortic vein - one of the largest blood vessels in the body. If injury occurs during surgery, the patient is at risk of massive blood loss, directly threatening life.
According to professional assessment, the fetal mass has developed with placental spines tending to invade the surrounding tissues. The gestational mass is located close to the large blood vessel, so the risk of placental spines penetrating the aortic vein wall is entirely possible. Even a small impact during surgery can lead to serious bleeding.
Faced with the complicated situation, the hospital quickly held a consultation and determined that this was a particularly difficult surgery. The entire preparation process was raised to the highest level of safety, from blood forecasting, active resuscitation preparation to building complication treatment scenarios. In particular, the team proactively contacted blood vessel experts from Viet Duc Friendship Hospital to be ready to coordinate when necessary.
The reality in the operating room shows that this preparation is completely necessary. BSCKII Nguyen Thanh Tuan, Central Obstetrics and Gynecology Hospital, the doctor directly performing the surgery, said that when the abdominal cavity was opened, the gestational mass was determined to be in the correct dangerous position as previously diagnosed, surrounded by about 600 grams of blood clots. Immediately, the team invited a vascular surgery specialist from Viet Duc Hospital to participate in treatment.
The coordination between the two surgical teams created a tight and precise treatment process down to each operation. The gestational block was carefully dissected, while checking and treating the lesions in the aorta. Fortunately, the lesions were only localized in the outer layer of the blood vessel, and the doctors proceeded to sew the restoration right during the surgery, ensuring the maintenance of the integrity of the blood vessel.
Notably, in addition to the initial amount of hematoma, the patient almost did not lose more blood throughout the surgery process. This is a result showing high professional level, good situation control ability and smooth coordination between teams.
After surgery, the patient recovered stably, progressed favorably and was discharged from the hospital after 5 days of treatment.
According to experts, this is one of the rare cases of ectopic pregnancy in a rare location, especially related to large blood vessels, always posing a very high risk. Early diagnosis, accurate assessment and preparation of multi-specialized coordination plans are decisive factors to help save patients in critical situations.
