Abstract
BackgroundRetroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 20 cases reported in the English literature. However, failure to recognize REP may result in severe consequences.Case presentationWe report a case of 32-year-old woman with REP. She had amenorrhea, left lower abdominal pain, but no vaginal bleeding. Her urine human chorionic gonadotropin (HCG) test was positive and blood HCG level was 1880 m-international units per milliliter (mIU/mL). Transvaginal ultrasound sonography showed a left adnexal mass. Laparoscopy found an enlarged uterus, normal right uterine tube and ovary, and normal left uterine tube. The left ovary was partly covered by a blood clot, but appeared normal after removing the clot. There was a 10-mm circular peritoneal defect located lateral to the left sacrocervical ligament, anterior to the left ovarian fossa, and next to the lower edge of the left broad ligament. The patient was diagnosed of having REP with the gestational tissues covered by the peritoneum. The REP was removed by laparoscopic surgery. Bleeding was stopped by bipolar coagulation and absorbable hemostatic cellulose. The patient recovered smoothly and was discharged on the next day after surgery. Her blood HCG returned to normal range 29 days after surgery.ConclusionsREP is very rare, but in any suspected case of ectopic pregnancy, caution must be paid to find signs of REP when the common sites of ectopic pregnancy do not have any positive findings.
Highlights
Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 20 cases reported in the English literature
The incidence of ectopic pregnancy has increased during the past decades, the maternal morbidity and mortality of ectopic pregnancy have decreased due to improvement in early diagnosis using high-resolution transvaginal ultrasound sonography (TVS) and laparoscopy [1]
The uterus appeared enlarged equivalent to the size of 40-daygestation, with smooth surfaces, but without bleeding; the right uterine tube and ovary appeared normal; the left uterine tube was normal (Fig. 1a); the left ovary was slightly enlarged, partly covered by a blood clot (Fig. 1a-1b), but had no rupture or bleeding after the clot was removed; there was a small amount of unclotted blood in the pouch of Douglas; there were no abnormal findings in the greater omentum, small intestines, colons, and mesenteries
Summary
REP is very rare, but in any suspected case of ectopic pregnancy, caution must be paid to find signs of REP when the common sites of ectopic pregnancy do not have any positive findings.
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