Interstitial ectopic pregnancy surgically managed with laparoscopic approach

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Interstitial pregnancy is an extremely rare form of ectopic pregnancy that commonly leads to uterine rupture, ensuing sudden life-threatening bleeding, emergency surgery and need for blood transfusion, and admission to the intensive care unit [1]. We report the case of a 33-year-old woman with a positive pregnancy test that presented with pelvic pain and reduced vaginal bleeding in the past three days. On ultrasound, we observed the presence of a cornual anechoic mass with a hyperechoic border, compatible with a tubal ring in the interstitial portion of the right tube, with a maximum diameter of 0,92 cm (Figure 1) and no free fluid in the Douglas pouch. The myometrium around the gestational sac was almost absent, establishing the diagnosis of interstitial pregnancy. At admission, serum ß-hCG level was 2212 UI/L. Clinically the patient was stable, without any signs or symptoms of acute abdomen.

Elective laparoscopic right salpingectomy with a cornual resection was performed (Figure 2,3) after extensive adhesiolysis (Figure 4) (the patient had a prior laparoscopic myomectomy). Serum ß-hCG progressively decreased, the patient was released home the day after the surgery.

Early recognition and timely management of interstitial pregnancy are crucial. The main concern with surgical treatment is hemorrhage and cornual reconstruction, which necessitates advanced laparoscopic skills and techniques [2,3]. Ultrasonography’s overall advances and a high index of suspicion have permitted an early diagnosis and minimum invasive surgical approach.