PROCEDURE IN DETAIL: The patient was prepped and draped in the usual manner and placed under adequate general anesthesia. A Pfannenstiel incision was performed and carried through the skin and subcutaneous tissue, fascia and the peritoneum. The peritoneal cavity was entered. The hemoperitoneum was noted, and approximately 500 mL of blood was rapidly evacuated from the pelvic cavity, as were large clots. Following this, the bowel was packed away from the pelvic area with packing laps. A retraining retractor was introduced. The left fallopian tube was noted. A large tubal ectopic pregnancy was noted affecting approximately the distal half of the fallopian tube.
Following this, a Heaney clamp was placed and the mesosalpinx and another curved Heaney clamp was placed in the proximal aspect of the left fallopian tube beyond the area of the ectopic pregnancy. A partial salpingectomy was then performed, removing the portion of the left fallopian tube containing the ectopic pregnancy. Heaney clamps were then replaced with sutures of No. 1 Vicryl. Hemostasis was checked again and no bleeding was detected. Further evacuation of blood and blood clots was then performed. The right fallopian tube was noted to be covered with adhesions both tubo-ovarian and tubo-uterine adhesions. The adhesions were then sharply lysed, freeing the right fallopian tube. Hemostasis was checked again. No bleeding was detected.
Mild serosal abrasion was noted from the area where the ectopic pregnancy was apparently attached to the bowel. This was not bleeding and was very superficial. Hemostasis was checked and no bleeding was detected.