Ectopic pregnancy in an incarcerated fallopian tube

Abstract

39-year-old woman with a history of 1 spontaneous vaginal delivery at term presented to our unit with a 5-year history of irregular menstruation and vaginal bleeding. Herhistoryincludeda first-trimestersurgicalevacuationofthe uterus in 2009. At the conclusion of the procedure a contraceptive ring was placed in the uterine cavity. Seven months earlier, she presented to the infertility clinic withcompleteamenorrheafor12months.Thecontraceptive ring was removed as she intended to try and achieve pregnancy. An ultrasound examination demonstrated a mobile mass associated with the right cornu of the uterus. Two months later, she presented in the clinic again with irregular vaginal bleeding. Vaginal examination demonstrated tenderness in the right adnexa. Her human chorionic gonadotropin level was 2540 IU/L. Laparoscopy showed an intrauterine incarceration of the fallopian tube close to the right cornu with enlargement of the ampulla (Figure 1). Hysteroscopy revealed a fistula in the posterior wall of the right side of the uterus (Figure 2, A) with uterine adhesions and endometrial polyps across the fundus of the uterus, and the fimbriated extremity of fallopian was found in the fistula (Figure 2, B). The polypoid lesion was resected and a contraceptive ring was placed inside the uterus to prevent intrauterine synechiae. A laparoscopic salpingectomy with adhesiolysis was performed. The fistula was resected and the uterus was repaired with absorbable sutures. Histopathological examinations of the resected specimens demonstrated an ectopic pregnancy in the ampulla of the fallopian tube. We propose that the sequence of events in this unusual case 1,2 included perforation of the uterus at the time on the initial surgical abortion. The insertion of the contraceptive