Surgical treatment of interstitial pregnancy without cornual resection: A case report

Abstract

Rationale: Interstitial pregnancy (IP) is a rare but extremely life-threatening form of ectopic pregnancy. The traditional surgical treatment for this anomaly is the resection of uterine cornua or fallopian tubes, which often damages their structural integrity, thereby compromising the reproductive potential for women who wish to preserve fertility. Patient concerns: A 33-year-old female was admitted to our hospital with suspected ectopic pregnancy, following a 4-weeks history of positive pregnancy tests after uterine evacuation. The patient was hemodynamically stable on arrival. Ultrasound revealed an empty uterus with an eccentric gestational sac located at the fundus and surrounded by a thin myometrium, indicative of a suspected interstitial pregnancy. Diagnosis and intervention: After failed attempt at medical management with a single dose of intramuscular methotrexate, the patient was arranged for hysteroscopy-assisted laparoscopy. In surgery, the uterine cavity appeared empty, and a 2 × 2 cm bulge with increased vascularity at the right uterine courna was identified upon examination. The gestational sac was aspirated through the vagina from the right ostium of the uterine tube using a suction curette pointing at the right ostium. Sutures were not needed afterward, and the myometrial anatomy was left undisrupted. The diagnosis of IP was confirmed by the postoperative histological report. Outcomes: Perioperative blood loss was approximately 10 ml and the operative time was 40 minutes. The patient had an uneventful postoperative recovery and was discharged after 3 days. Subsequent follow-ups showed a significant reduction in the patient serum beta hCG to 48IU/L within 5 days postoperation, and a negative result after 7 days. Lessons: This novel surgical technique is an alternative minimally-invasive approach for selected early diagnosed and hemodynamically stable IP patients. The technique represents a safe, quick, and simple approach combining the benefits of laparoscopy, such as allowing for immediate conversion of cornuectomy when uterus ruptures, and the benefits of suction curettage, such as shorter operative time and minimal blood loss. We believe patients with interstitial pregnancy who still have fertility wishes would benefit from this surgical technique to a larger extent in the future.

Interstitial Ectopic Pregnancy—Case Reports and Medical Management

“…The evacuation of the gestational sac was carried out transvaginally under laparoscopic supervision. Similarly, Feng et al [ 33 ] described a case of a patient diagnosed with IP. They were initially unsuccessfully treated with MTX, and then subsequently with laparoscopic-assisted hysteroscopy [ 33 ].…”

“…The combined method, described as hysteroscopy-assisted laparoscopy, was described by some authors as an alternative minimally invasive approach that could be appropriate in some patients with IP. The prerequisites included early recognition of the abnormality and the woman’s hemodynamically stable condition [ 32 , 33 ]. Katz et al [ 32 ] presented two cases of patients with diagnosed IP who were successfully treated with laparoscopic-assisted hysteroscopy.…”

“…They were initially unsuccessfully treated with MTX, and then subsequently with laparoscopic-assisted hysteroscopy [ 33 ]. In all the cases presented, cornual resection was not necessary, which is undoubtedly an advantage of this method [ 32 , 33 ].…”

“…Thus, it is important to promptly recognize the classic ultrasound presentation. The awareness of appropriate diagnostic approaches, differential diagnoses as well as conservative and surgical treatment methods are equally vital [ 1 , 9 , 14 , 15 , 16 , 17 , 18 , 29 , 32 , 33 , 34 , 35 , 36 ].…”

Cornual pregnancy rupture and massive hemorrhage: A case report

“…Some scholars have proposed that “the cervix is longer and the lower segment of the uterus is thickened” or “the amniotic cavity is far from the cervix.” These findings, as well as the placenta implantation at 1 corner of the uterus, constitute important clues for the diagnosis of cornual pregnancy in the second and third trimester of pregnancy. [ 6 ] Therefore, it is considered that the long axis section of the cervix should be examined by ultrasound for pregnant patients at any gestational week. In addition, this examination point can also be considered in cases that cannot be determined by ultrasound.…”