Ectopic Ovary at Ectopic Pregnancy

Abstract

Fig. 1. Twisted left tubal ectopic pregnancy with ectopic left ovary (OV). A 33-year-old woman presented at the emergency department with a 3-day history of abdominal pain and mild vaginal bleeding at 7 weeks amenorrhea. She was anxious but with stable vital signs (blood pressure 115/78 mmHg, pulse rate 86). The serum b-human chorionic gonadotropin level was 1226 IU/mL, and transvaginal ultrasonography, done with moderate discomfort, revealed hemoperitoneum, an empty uterus, and an adnexal mass adjacent to the left ovary suggestive of a tubal ectopic pregnancy. Emergency laparoscopy revealed a twisted left tubal ectopic pregnancy wrapping around a left ectopic ovary attached near the uterosacral ligament. The ovary had no ovarian or infundibulopelvic ligament but only rudimentary vascular attachment to the base of the broad ligament lateral to the uterosacral ligament (Fig. 1). The right ovary was normal with no aberration to its ovarian and infundibulopelvic ligaments. The uterus was normal, and both ureters were visualized in their anatomic positions. Ectopic ovary is a rare gynecologic condition. Case reports have described ectopic ovary attached to omentum [1], colon [2], pouch of Douglas [3], inguinal canal [4], and even at the labia majora [5]. The cause of ectopic ovary is unknown, with some attributing the cause to congenital aberration. Others have proposed an acquired mechanism of torsion leading to autoamputation and subsequent reimplantation at an ectopic site. Lachman and Berman [6] divided the origin of ectopic ovary into post surgical implantation, postinflammatory implantation, and true embryological aberration. This case illustrates an interesting finding of ectopic ovary at tubal ectopic pregnancy.