Successful Procedure in Conservative Management of Interstitial (Cornual) Ectopic Pregnancy (original) (raw)

2019, Gynecology and Minimally Invasive Therapy

IntRoductIon Interstitial (cornual) pregnancy is a rare type of ectopic pregnancy, accounting for 2%-4% of all tubal pregnancies, but with high maternal mortality of 2%-2.5%. [1] Interstitial pregnancy refers to an ectopic pregnancy that is implanted in the tubal segment traversing the muscular wall of the uterus. This section of tube is relatively thick, and it is located in highly vascular region. Therefore, interstitial ectopic pregnancy tends to rupture later, with more severe bleeding than those of other ectopic pregnancies. [2] Predisposing factors to interstitial pregnancy include history of previous ectopic pregnancy, ipsilateral salpingectomy, and in vitro vertilization. [1] Transvaginal ultrasound scan is imperative for the early diagnosis of interstitial pregnancy. A previous study outlined three sonographic criteria for diagnosis: (1) an empty uterine cavity, (2) a chorionic sac seen separately and at least 1 cm from the lateral edge of uterine cavity, and (3) a thin (<5 mm) myometrial layer surrounding the gestational sac. [3] In the past, interstitial pregnancy was commonly treated by hysterectomy or cornual resection by laparotomy. [2] Recently, more conservative laparoscopic approaches have been developed, including cornual resection, cornuostomy, salpingostomy, and salpingectomy. [1] Aside from surgical treatment, interstitial pregnancy can also be managed medically using systemic or local injection of methotrexate. [2] Here, we present a case report of a 35-year-old woman with interstitial pregnancy who underwent a successful conservative laparoscopic cornuostomy. case RepoRt A 35-year-old woman, gravida 2, para 1, presented to the outpatient clinic with spotting and lower abdominal pain. She A 35-year-old woman presented with spotting and lower abdominal pain. Follow-up sonography was suggestive of interstitial ectopic pregnancy. Laparoscopic cornuostomy was carried out. Before incision, diluted vasopressin was injected around the site of interstitial pregnancy. Removal of the conceptual tissues was conducted smoothly through a 1.5 cm incision. The overall blood loss was 50 mL. The operative time was 50 min, and there were no intraoperative complications. We successfully performed laparoscopic cornuostomy, which was followed by an unremarkable postoperative course. Laparoscopic surgery is a safe and effective minimally invasive surgical intervention for interstitial ectopic pregnancy if performed by the experienced surgeon. Local vasopressin injection is a good alternative for bleeding control in conservative laparoscopic surgery.