Tubal ectopic pregnancy two years after laparoscopic supracervical hysterectomy

Abstract

BackgroundEctopic pregnancy after hysterectomy is a very rare condition, but it must be kept in mind in women with history of hysterectomy who present with abdominal pain and ecographic adnexal heterogeneous images. Since first described by Wendeler in 1895, at least 67 ectopic pregnancies (tubal, ovarian and abdominal) have been described in patients subjected to prior hysterectomy.Case presentationWe describe the case of a 41-year-old white caucasian woman admitted to the emergency room due to abdominal pain for two days. The ultrasounds scan and the quantification of beta-HCG led to the diagnosis of tubal ectopic pregnancy, although she had been hysterectomized two years before. An emergency laparoscopy was performed for salpingectomy. The pathology report indicated trophoblastic tubal implantation and hematosalpinx.ConclusionsEctopic pregnancy is one of the conditions to be considered in the differential diagnosis of abdominal pain in women of child bearing potential, and the absence of the uterus does not rule out its diagnosis.

Ectopic pregnancy after hysterectomy may not be so uncommon: A case report and review of the literature

“…Subtotal hysterectomy has increased in the United States in the past decade, estimated to now make up 7.5% of all hysterectomies performed [70] , [71] , [72] . Fourteen cases of “late presentation” ectopic pregnancy have followed supracervical or cesarean hysterectomy, including the current case [33] , [34] , [36] , [37] , [56] , [59] , [61] , [63] , [65] , [66] , [67] , [68] . Leaving a remnant of the cervix or the epithelialization of a much larger vaginal cuff closure area because of cervical dilation at the time of cesarean hysterectomy may increase fistulous tract formation [54] , [73] .…”

A Case of Ectopic Tubal Pregnancy Eight Years After a Hysterectomy Presenting as a Diagnostic Challenge

“…The initial differential diagnoses that should be excluded also include gastrointestinal diseases that include appendicitis, bowel obstruction, diverticulitis, gastritis, irritable bowel syndrome, and mesenteric venous thrombosis, and urinary tract diseases, including cystitis, and pyelonephritis. The diagnosis of ectopic pregnancy is more likely to be made in cases with an early presentation in the immediate period after hysterectomy, but this was a case with a late presentation, which is much rarer [1,3]. However, as this case has shown, even in late cases of ectopic pregnancy, measurement of serum levels of human chorionic gonadotropin (hCG) are important to make the diagnosis, although some malignant tumors can be associated with increased serum hCG, including hepatic, gastric, pancreatic, ovarian, and breast cancer as well as neuroendocrine tumors.…”

“…Currently, 73 cases of this rare condition have previously been reported, with the last case being reported by Ahmed et al in May 2019 [2]. Ectopic tubal pregnancy after hysterectomy includes an early presentation in the immediate period after hysterectomy, which represents most of the reported cases, and late presentation from seven months to 12 years after hysterectomy [1,3]. In cases of early presentation, an undiagnosed pregnancy existed at the time of hysterectomy [1,4].…”

Tubal Ectopic Pregnancy 12 Weeks after Laparoscopic Supracervical Hysterectomy and Tubal Ligation

“…At least 67 ectopic pregnancies (abdominal, ovarian, and tubal) have been reported in patients previously subjected to hysterectomy, since its description for the first time in 1895 (1)(2)(3)(4)(5)(6)(7)(8). Two forms of presentation are described in the literature for ectopic pregnancies in patients who had undergone hysterectomies: early and late presentations (3).…”