EMBARAZO ECTÓPICO ABDOMINAL AVANZADO CON MUERTE FETAL PROLONGADA Y ABDOMEN AGUDO OBSTRUCTIVO: REPORTE DE CASO RARO Y REVISIÓN DE LA LITERATURA
DOI:
https://doi.org/10.56238/revgeov17n3-189Palabras clave:
Litopedion, Embarazo Ectópico Abdominal, Muerte Fetal, Abdomen Agudo, Laparotomía, Vulnerabilidad SocialResumen
Reportamos un caso raro de embarazo ectópico abdominal avanzado con muerte fetal prolongada que evolucionó a abdomen agudo obstructivo en una mujer multípara de 39 años, en situación de vulnerabilidad social y con antecedente de consumo de múltiples sustancias. El caso pone de relieve los desafíos diagnósticos y terapéuticos de los embarazos ectópicos abdominales, una condición asociada a alta morbilidad y mortalidad materna, en la cual la detección temprana suele verse dificultada por síntomas inespecíficos y la ausencia de control prenatal. El diagnóstico fue inicialmente sugerido por ecografía y posteriormente confirmado mediante laparotomía exploratoria, que reveló un feto fallecido libre en la cavidad abdominal, una placenta trombosada y extensas adherencias intestinales, compatibles con obstrucción intestinal aguda. Un abordaje quirúrgico multidisciplinario, que involucró equipos de obstetricia y cirugía general, permitió la extracción segura del feto retenido, la liberación de adherencias y la resolución del proceso obstructivo, resultando en un desenlace materno favorable. Este caso subraya la importancia de la vigilancia obstétrica continua, la atención integral a la salud de la mujer y el fortalecimiento de las redes de atención para poblaciones socialmente vulnerables, en las cuales condiciones graves pueden permanecer sin diagnóstico durante largos períodos.
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Referencias
Aboubechara, J. P., & Aboud, O. (2024). Metabolic risk factors and survival in patients with glioblastoma. Cancers, 16(21), 3666.
Agopiantz, M., et al. (2023). Hormone receptor expression in meningiomas: A systematic review. Cancers, 15(3), 980.
Aninditha, T., et al. (2021). Adults brain tumor in Cipto Mangunkusumo General Hospital: A descriptive epidemiology. Romanian Journal of Neurology, 20(4), 480–484.
Bah, A. B., et al. (2025). Complications of brain tumor surgery. Surgical Neurology International, 16, 301.
Bersot, C. D. A., et al. (2025). Enhanced recovery after surgery in elective craniotomy: A systematic review and meta-analysis of perioperative outcomes. Clinical and Translational Neuroscience, 9(3), 39.
Bharadwaj, S., et al. (2023). Perioperative care practices and outcomes of intracranial neurosurgery: Experience at a dedicated neurosciences hospital in a developing country. Journal of Anaesthesiology Clinical Pharmacology, 39(4), 622–627.
Bilotta, F., Guerra, C., & Rosa, G. (2013). Update on anesthesia for craniotomy. Current Opinion in Anaesthesiology, 26(5), 517–522.
Brasil. Ministério da Saúde. (2011). Orientações para a coleta e análise de dados antropométricos em serviços de saúde: Norma técnica do Sistema de Vigilância Alimentar e Nutricional – SISVAN. Ministério da Saúde.
Buffon, V., et al. (2022). Perfil epidemiológico de tumores intracranianos metastáticos submetidos à neurocirurgia. BioScience, 80(2), 23.
Canto, A. B., et al. (2025). Perfil epidemiológico de tumores cerebrais em centro único em Indaiatuba. In Neurologia: Diagnósticos, tratamentos e cirurgias (9ª ed., pp. 23–28). Editora Pasteur.
Carstam, L., et al. (2020). Socioeconomic factors affect treatment delivery for patients with low grade glioma: A Swedish population-based study. Journal of Neuro-Oncology, 146(2), 329–337.
Chand, S., et al. (2021). Patient blood management in a neurosurgical patient with anti-e antibody. Asian Journal of Transfusion Science, 15(2), 226–228.
Cobo, B., Cruz, C., & Dick, P. C. (2021). Desigualdades de gênero e raciais no acesso e uso dos serviços de atenção primária à saúde no Brasil. Ciência & Saúde Coletiva, 26, 4021–4032.
Cottrell, J. E., Patel, P. M., & Warner, D. S. (2017). Cottrell and Patel’s neuroanesthesia. Elsevier.
Dhingra, A., et al. (2025). Effects of anesthesia on tumor perfusion and infiltration during brain tumor neurosurgery. Annals of Medicine and Surgery, 87(7), 4201–4208.
González, D. G., et al. (2025). Perioperative anesthetic management and postoperative outcomes of patients treated with CyberKnife robotic radiosurgery. Revista Española de Anestesiología y Reanimación, 72(3).
Godoi, B. B., et al. (2022). Brain tumors epidemiology in a low-income health region of Brazil. Jornal Brasileiro de Neurocirurgia, 33(2), 165–171.
Hsu, S.-Y., & Huang, Y.-H. (2016). Characterization and prognostic implications of significant blood loss during intracranial meningioma surgery. Translational Cancer Research, 5(6), 797–804.
Ismail, M., et al. (2024). Perioperative blood transfusion management in surgical resection of intracranial meningiomas: A meta-analysis. Surgical Neurology International, 15, 256.
Katzke, V. A., Kaaks, R., & Kühn, T. (2015). Lifestyle and cancer risk. The Cancer Journal, 21(2), 104–110.
Kumar, S., et al. (2025). Perioperative complications in elderly patients undergoing intracranial surgery: A prospective observational study. Journal of Neuroanaesthesiology and Critical Care, 12(2), 83–88.
Lenet, T., et al. (2023). Intraoperative blood management strategies for patients undergoing noncardiac surgery: The Ottawa intraoperative transfusion consensus. JAMA Network Open, 6(12), e2349559.
Lenga, P., et al. (2024). Optimizing patient outcome in intracranial tumor surgery: A detailed prospective study of adverse events and mortality reduction strategies in neurosurgery. Acta Neurochirurgica, 166(1), 126.
Leeper, H. E., et al. (2023). Association of employment status with symptom burden and health-related quality of life in people living with primary CNS tumors. Neurology, 100(16).
McHayle, A., et al. (2021). Operative duration and early outcomes in patients having a supratentorial craniotomy for brain tumor: A propensity matched analysis. Journal of Clinical Neuroscience, 92, 207–214.
Meza-García, C. F., et al. (2022). Panorama epidemiológico de las neoplasias encefálicas con tratamiento quirúrgico en un hospital de tercer nivel en Guanajuato, México. SANUS, 7, e246.
Moura, J. N., et al. (2021). Perfil epidemiológico e cirúrgico de pacientes neuro-oncológicos submetidos a cirurgias neurológicas. Cogitare Enfermagem, 26.
Ostrom, Q. T., et al. (2022). CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2015–2019. Neuro-Oncology, 24(Suppl. 5), v1–v95.
Padevit, L., et al. (2019). Smoking status and perioperative adverse events in patients undergoing cranial tumor surgery. Journal of Neuro-Oncology, 144(1), 97–105.
Patrício, A. C. de A., Cristino, A. C. C., & Aquino, T. A. A. de. (2023). Espiritualidade e religiosidade na saúde de pacientes oncológicos sob a ótica das ciências das religiões: Uma revisão de escopo. Interações, 18(2).
Pebes Vega, J. C., et al. (2025). Nutritional assessment and management of patients with brain neoplasms undergoing neurosurgery: A systematic review. Cancers, 17(5), 764.
Punchak, M. A., et al. (2025). Association between sociodemographic variables and delayed patient presentation among surgical neuro-oncology patients in Mexico City: A single institution experience. Journal of Neuro-Oncology, 171(1), 191–199.
Rail, B., et al. (2022). Transfusion guidelines in brain tumor surgery: A systematic review and critical summary of currently available evidence. World Neurosurgery, 165, 172–179.
Rajagopalan, V., et al. (2019). Effect of intraoperative blood loss on perioperative complications and neurological outcome in adult patients undergoing elective brain tumor surgery. Journal of Neurosciences in Rural Practice, 10(4), 631–640.
Ribeiro, K., et al. (2015). Low educational level is associated with advanced cancer stage in Brazil. International Journal of Epidemiology, 44(Suppl. 1), i3–i4.
Rodrigues, D. B., et al. (2014). Epidemiologia das neoplasias intracranianas no Hospital do Servidor Público Estadual de São Paulo: 2010–2012. Arquivos Brasileiros de Neurocirurgia, 33(1), 6–12.
Santos, B. L., et al. (2021). Tumores primários do sistema nervoso central em Sergipe, Brasil: Epidemiologia descritiva entre 2010 e 2018. Arquivos de Neuro-Psiquiatria, 79, 504–510.
Sharma, A., et al. (2022). Study of association of various psychiatric disorders in brain tumors. Asian Journal of Neurosurgery, 17(4), 621–630.
Shi, M., et al. (2023). Alcohol consumption among adults with a cancer diagnosis in the All of Us Research Program. JAMA Network Open, 6(8), e2328328.
Vani, G. (2021). Perfil epidemiológico de tumores primários e secundários do sistema nervoso central atendidos em hospital de referência no sul do Brasil (Monografia de graduação). Universidade Federal da Fronteira Sul.
Vega, J. C. P., et al. (2025). Nutritional assessment and management of patients with brain neoplasms undergoing neurosurgery: A systematic review. Cancers, 17(5), 764.
Von Elm, E., et al. (2008). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61(4), 344–349.
Winn, H. R. (2022). Youmans and Winn neurological surgery (4 vols.). Elsevier Health Sciences.
Xiao, S., et al. (2023). Development and validation of a prediction tool for intraoperative blood transfusion in brain tumor resection surgery: A retrospective analysis. Scientific Reports, 13(1), 17428.
Yang, Y., et al. (2021). The association of patient age with postoperative morbidity and mortality following resection of intracranial tumors. Brain and Spine, 1, 100304.
Zhang, Y.-B., et al. (2020). Combined lifestyle factors, incident cancer, and cancer mortality: A systematic review and meta-analysis of prospective cohort studies. British Journal of Cancer, 122(7), 1085–1093.
