Untitled

Abstract

An unusual case of retroperitoneal ectopic pregnancy is reported. The patient, a 34 year old nulligravida, underwent IVF/ET following bilateral salpingectomy. A small, degenerating, intrauterine gestational sac suggested failing intrauterine pregnancy. There was no intraperitoneal free fluid. On Day 41 after ET, the patient was hospitalized because of acute epigastric pains. A pseudocyst of the head of pancreas was demonstrated by CT scan. A day later, exploratory laparotomy, because of a precipitous drop in the hemoglobin, revealed a massive retroperitoneal hematoma and an embryo in the gestational sac attached to the head of pancreas and major blood vessels. The patient did well following surgery. The mechanisms of retroperitoneal embryo migration are discussed and literature is reviewed.

Early Abdominal Ectopic Pregnancies: A Systematic Review of the Literature

“…There were 10 cases of an abdominal pregnancy being implanted retroperitoneally [151,152,153,154,155,156,157,158,159,160]. The average age at diagnosis was 8 weeks 5 days with a range of 5–18 weeks with an average maternal age of 29.4 years and parity of 1.1.…”

“…Four of the patients had IVF with 3 patients having a history of bilateral salpingectomy [153,156,159], and the remaining patient with history of right salpingectomy and left hydrosalpinx with an occluded tube [154]. Four of the women required a blood transfusion [153,154,155,156].…”

Diagnosis and Treatment of Retroperitoneal Ectopic Pregnancy: Review of the Literature

“…Reported sites of primary abdominal pregnancy are the pouch of Douglas, posterior uterine wall, uterine fundus, infundibulopelvic ligaments, anterior abdominal wall, omentum, liver, spleen and diaphragm [4]. However, abdominal pregnancy in the retroperitoneal space is an exceedingly rare occurrence, and only 12 such cases have been reported previously in the English-language literature [1,6,7,8,9,10,11,12,13,14,15,16] (table 1). …”

“…As already stated, most patients with REP have a history of in vitro fertilization (8 of 12) [1,6,8,10,11,13,14,15] (table 1). It is difficult to explain how the embryo reaches the retroperitoneal sites.…”

Ectopic pregnancy (tubal and retroperitoneal) after in vitro fertilization with double embryo transfer

“…Ретроперитонеальная эк-топическая беременность (РЭБ) является крайне редким вариантом из всех эктопических беременно-стей, а эктопическая беременность двойной локали-зации (трубная и ретроперитонеальная) являет со-бой казуистический случай. При поиске литературы в MEDLINE через PubMed обнаружено в англо-язычной литературе 14 наблюдений РЭБ, русско-язычных публикаций на эту тему не обнаружено [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. РЭБ трудно диагностировать ввиду ее ред-кости, недоступности для трансвагинальной ультра-сонографии и схожести ее с другими заболевания-ми, такими как забрюшинная хорионкарцинома [3].…”