A Cautionary Tale of the Tubal Stump

Abstract

A 22 year-old G2A1 female, with a history of prior right salpingectomy for a ruptured ectopic pregnancy, presented to hospital with diffuse abdominal pain and vaginal spotting. Her b-HCG was over 16 000 mIU/mL. A pelvic ultrasound demonstrated a gestational sac with a fetal pole at the right utero-tubal junction, outside of the endometrial cavity (Figure 1), suggesting a pregnancy contained in the interstitium of the tubal stump remnant. Laparoscopy confirmed imaging findings (Figure 2). Dilute vasopressin was injected into the adjacent myometrium. A transverse incision was made along the most dependent area of the interstitial pregnancy, the products of conception were expressed from the uterine cornua, tubal stump removed, and the defect repaired (Figure 3). Figure 2Laparoscopy confirms an interstitial ectopic pregnancy within the tubal stump from prior salpingectomy. View Large Image Figure Viewer Download Hi-res image Figure 3Image of the pelvis after removal of ectopic pregnancy and repair View Large Image Figure Viewer Download Hi-res image