Laparoscopic Management of Interstitial Ectopic Pregnancy Following Ipsilateral Salpingo-Oophorectomy for Granulosa Cell Tumor

Abstract

<h3>Study Objective</h3> To describe a unique laparoscopic surgical technique for the management of a highly unusual incidence of interstitial ectopic pregnancy following ipsilateral salpingo-oophorectomy. <h3>Design</h3> Case report <h3>Setting</h3> Patient presented to the emergency room of a community hospital where she was diagnosed with an ectopic pregnancy. She was brought to the operating room where diagnostic laparoscopy confirmed right interstitial ectopic pregnancy with prior surgically removed right ovary and fallopian tube. <h3>Patients or Participants</h3> 34-year-old G4P2012 with history of right ovarian granulosa cell tumor, status post right salpingo-oophorectomy eight months prior, presented with vaginal bleeding and pelvic pain. <h3>Interventions</h3> A unique laparoscopic surgical approach involving blunt dissection of the interstitial pregnancy followed by electrocautery of the implantation site. The patient was followed with serial bHCG levels. <h3>Measurements and Main Results</h3> A minimally invasive approach with laparoscopy was used for the management of the interstitial ectopic pregnancy. The products of conception were grasped through a thin, nearly ruptured serosa and bluntly dissected off the implantation site. The implantation site was then cauterized and two hemostatic agents were applied. There were no complications. The patient was discharged on postoperative day zero. Her postoperative course was uncomplicated. She was followed with serial bHCG levels, which progressively dropped to a negative value without the addition of methotrexate. <h3>Conclusion</h3> Interstitial pregnancy is a rare type of ectopic pregnancy. This already rare occurrence is far more unusual following an ipsilateral salpingo-oophorectomy. Only one other similar case was identified through thorough literature review. Here we describe a unique laparoscopic approach for the management of an interstitial ectopic pregnancy following ipsilateral salpingo-oophorectomy. This particular technique could have benefit compared to more standard technique, such as the wedge resection, because it allows less advanced minimally invasive surgeons to maintain a minimally invasive approach. This approach may also reduce risks to patient by avoiding the addition of methotrexate and deep myometrial incisions.