Retroperitoneal ectopic pregnancy: A literature review of reported cases

OuYang, Zhenbo; Wei, Shiyuan; Wu, Jiawen; Wan, Zixian; Zhang, Min; Zhong, Biting

doi:10.1016/j.ejogrb.2021.02.014

Cited by 18 publications

(25 citation statements)

References 25 publications

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“…There are seven subtypes: adnexal, interstitial, ovarian, cesarean scar, heterotopic, cervical, and abdominal (Table 1). Retroperitoneal EPs are exceedingly rare, with only 9 cases reported since 2018 [1]. At a mortality rate of 9-14%, ruptured EPs are the leading cause of maternal death within the first trimester of pregnancy [2] and account for approximately 5-10% of all pregnancy-related deaths [3].…”

Section: Introductionmentioning

confidence: 99%

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

2021

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Ectopic pregnancy (EP) is a term used to describe any pregnancy which does not implant into the uterine cavity. There are several types of EPs: tubal, interstitial, ovarian, abdominal, heterotopic, cervical, and cesarean scar. Ectopic pregnancies can acutely rupture and are the number one cause of maternal death in the first trimester of pregnancy. Therefore, prompt recognition and accurate localization have significant clinical implications on patient outcome. Unfortunately, EPs have many mimickers, which can make the diagnosis challenging in certain cases. In this review, we aim to describe and illustrate sonographic findings of each type of EP, as well as present mimickers and various imaging pitfalls. We will clarify how to avoid potential misdiagnoses that could adversely affect patient outcomes. Lastly, we will briefly address management of each type of EP and discuss potential complications.

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Section: Introductionmentioning

confidence: 99%

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

2021

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“…However, in fact, most of the reported REPs located along the great vessels. Ouyang et al [ 3 ] suggested that, according to the implantation site, REP can be simply divided into two types: pelvic REP and abdominal REP. The former refers to the REP in the pelvic segment below the common iliac vessels, accounting for 27.3% (9/33); the latter refers to the REP around the abdominal aorta, the inferior vena cava, and the common iliac artery, accounting for 72.7% (24/33).…”

Section: Discussionmentioning

confidence: 99%

“…Nearly all ectopic pregnancies (95%) are implanted in the fallopian tube, whereas only merely 1% of ectopic pregnancies are implanted in the abdominal cavity [ 2 ]. Retroperitoneal ectopic pregnancy (REP), in which the gestational sac is implanted in the retroperitoneal cavity of the pelvis and abdomen, refers to an extremely rare type of abdominal ectopic pregnancy [ 3 ]. Once a retroperitoneal gestational sac ruptures, it can cause a catastrophic hemorrhage, especially for those located close to large blood vessels [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Retroperitoneal ectopic pregnancy (REP), in which the gestational sac is implanted in the retroperitoneal cavity of the pelvis and abdomen, refers to an extremely rare type of abdominal ectopic pregnancy [ 3 ]. Once a retroperitoneal gestational sac ruptures, it can cause a catastrophic hemorrhage, especially for those located close to large blood vessels [ 3 – 5 ]. Here we report a case of REP implanted on the surface of the inferior vena cava, as well as the abdominal aorta, which was successfully treated in a multidisciplinary team.…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary treatment of retroperitoneal ectopic pregnancy: a case report and literature review

Cheng

Yang

et al. 2022

BMC Pregnancy Childbirth

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Background Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 32 cases reported in the English literature. Early diagnosis of REP is very difficult and all treatments entail a high risk of life-threatening complications. Case presentation A 29-year-old nulliparous woman presented a history of 50-day amenorrhea and 7-day upper abdominal pain without vaginal spotting. The serum beta-human chorionic gonadotropin (β-hCG) value was 65,004 m-international units per milliliter (mIU/mL), but no intrauterine gestational sac was found via transvaginal sonography (TVS). Then transabdominal ultrasonography (TAS) and abdominal contrast-enhanced computer tomography (CT) identified a retroperitoneal ectopic pregnancy (REP) tightly adjacent to the inferior vena cava and the abdominal aorta. After consultation from a multidisciplinary team, systemic methotrexate (MTX, intramuscular 20 mg daily for 5 consecutive days) combined with ultrasound-guided local potassium chloride solution injection into the gestational sac was scheduled firstly for the patient. However, serum β-hCG continued to increase and the patient experienced worsening abdominal pain. Laparotomy was performed jointly by a gynecologist and a vascular surgeon. During the operation, the gestational sac with fetal bud measuring about 4.5 × 4.0x3.0 cm, tightly adherent to the surface of inferior vena cava and the left side of abdominal aorta, was carefully dissociated out from the surrounding tissues and removed en bloc. Histopathology examination confirmed the diagnosis of REP. The patient recovered uneventfully and her serum β-hCG returned to normal range on the 23th postoperative day. Conclusions Considering the possibility of REP and combined radiological examinations, such as ultrasonography and CT, are crucial for the early diagnosis of this rare condition. A multidisciplinary team is necessary to treat REP.

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“…Abdominal ectopic pregnancies, in general, and REPs, in particular, are associated with high mortality rates due to late diagnoses and unconventional treatments, which can include surgery or chemotherapy. As the use of assisted reproductive techniques (ART) has increased, reported REPs have also increased, and many reported REPs are associated with ART procedures, including embryo transfer (ET) after bilateral salpingectomies [5] .…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal ectopic pregnancy after in vitro fertilization: A case report of a patient with bilateral salpingectomy

Anh

Hải²,

Ha³

et al. 2022

Radiology Case Reports

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Retroperitoneal ectopic pregnancy (REP) is a rare obstetric condition caused by the mislocalization of the gestational mass. The unexpected location often results in missed or delayed diagnoses, which can complicate the treatment process. We report the case of a 34-year-old Asian woman who presented to the hospital 31 days after embryo transfer with mild vaginal bleeding. A history of bilateral salpingectomies was established. Two operations were performed before we were able to successfully remove the gestational sac from the retroperitoneal cavity. The histologic finding suggested an interesting migration pathway for the pregnancy. REP should be considered when a visible gestational sac cannot be detected on ultrasound in the expected locations, particularly among patients who undergo treatment using assisted reproductive techniques (ART), and have a history of bilateral salpingectomies. Magnetic resonance imaging (MRI) plays a vital role in diagnosing REP and guiding surgical interventions. A multidisciplinary team is necessary to treat REP, and monitoring beta-human chorionic gonadotropin (βHCG) levels and histologic findings remain essential during follow-up.

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Retroperitoneal ectopic pregnancy: A literature review of reported cases

Cited by 18 publications

References 25 publications

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

Multidisciplinary treatment of retroperitoneal ectopic pregnancy: a case report and literature review

Retroperitoneal ectopic pregnancy after in vitro fertilization: A case report of a patient with bilateral salpingectomy

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