Recurrent Ipsilateral Ectopic Pregnancy After Partial Salpingectomy

Abstract

Ectopic pregnancies are those that occur in any place other than the uterine cavity. During the last 20 years, the incidence of ectopic pregnancies has increased fourfold and now accounts for up to 2% of all pregnancies in the United States [1]. Ectopic pregnancy is an important issue during early pregnancy because of the associated maternal morbidity and even mortality [2]. Here, we present two patients with unusual ipsilateral tubal remnant ectopic pregnancies: one occurring in the proximal remnant of the fallopian tube and the other in the distal remnant of the fallopian tube. Both patients had undergone previous partial salpingectomies with laparoscopy. In Case 1, a 38-year-old multigravid woman with a history of previous ectopic pregnancy had undergone laparoscopic right partial salpingectomy 2 years prior to this admission. She had suffered from low abdominal pain for 2 days and had a positive pregnancy test result at the emergency department (ED) of Taipei Medical University–Wan Fang Medical Center. The concentration of serum β subunit of human chorionic gonadotropin (β-hCG) at the ED was 8,869 mIU/mL. The findings of a pretreatment ultrasound examination performed at the ED were consistent with an empty uterus with a moderate amount of cul-de-sac fluid. An ectopic pregnancy with internal bleeding was suggested. The patient underwent therapeutic laparoscopic surgery with diagnostic dilatation and curettage (D&C). The findings of the laparoscopic surgery revealed hemoperitoneum and a bulging mass about 2 cm in diameter at the proximal end of the previous partial salpingectomy remnant area (Figure 1). All the intra-abdominal bloody contents were evacuated during surgery, and the portion of the tube was removed and sent for pathologic examination. Corpus luteum was noted in the patient’s left ovary. Histopathologic examination of the laparoscopic specimen showed a fallopian tube with trophoblast, which was consistent with the findings of a tubal pregnancy. Examination of the D&C specimen showed the existence of decidual tissues. Our patient was, therefore, diagnosed with an ipsilateral ectopic pregnancy in the proximal tubal remnant portion of the previous partial salpingectomy. In Case 2, a 29-year-old multigravid woman with a history of previous ectopic pregnancy had undergone laparoscopic right partial salpingectomy 3 years prior to this admission. At presentation, she was suffering from severe low abdominal pain and had a positive pregnancy test result at the obstetrics and gynecology clinic of Taipei Medical University–Wan Fang Medical Center. The serum level of β-hCG on admission was 14,638 mIU/mL. The findings of a pretreatment transvaginal ultrasound examination performed at our