Abstract
A 38-year-old woman, gravida 3, para 1 with a history of a left salpingectomy for an ectopic pregnancy was admitted for treatment of a presumed ectopic pregnancy. Transvaginal sonography revealed an ill-defined gestational sac and fetal heart beat within the fundal myometrium adjacent to the left cornua. Laparoscopy was performed for a suspected left cornual pregnancy or intramural pregnancy. A cystic mass 3 cm in diameter was visible within the fundal myometrium. Total laparoscopic removal of the gestational sac was performed, and the uterus was preserved. Pathologic evaluation of the excised mass demonstrated chorionic villi involving the myometrium. In the literature, only one other case describing the laparoscopic removal of an intramural pregnancy has been reported. However, in the prior report, the patient still required hysterectomy after conservative surgery. Therefore, this is the first report of the successful treatment of an intramural pregnancy exclusively with laparoscopy.
Highlights
Intramural pregnancy is one of the rarest types of ectopic pregnancy [1]
A 38-year-old woman, gravida 3, para 1 with a history of a left salpingectomy for an ectopic pregnancy was admitted for treatment of a presumed ectopic pregnancy
Transvaginal sonography revealed an ill-defined gestational sac and fetal heart beat within the fundal myometrium adjacent to the left cornua
Summary
Intramural pregnancy is one of the rarest types of ectopic pregnancy [1]. In the literature, almost all cases have been treated with laparotomy or medication (methotrexate or potassium chloride). There is only one prior report describing the laparoscopic removal of an intramural pregnancy [2]. A 38-year-old woman, gravida 2, para 1 was admitted for a presumed ectopic pregnancy She presented with amenorrhea and a positive urine hCG test. Laparoscopic findings in the pelvic cavity were a uterus the size of eight-week gestation with a cystic mass 3 cm in diameter visible in the left fundal myometrium. This cyst was distinct from the residual left fallopian tube (Figure 2). Followup hysterosalpingography (HSG) three months postoperatively showed no change in the appearance of the uterus (Figure 6) as compared with an HSG obtained prior to the pregnancy. The absence of a filling defect confirmed that the tissue removed was not a horn of a bicornuate uterus (Figure 7)
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