Retroperitoneal ectopic pregnancies (REP) are extremely rare, and early diagnosis and treatment is very difficult. We completed an English literature search in MEDLINE through PubMed for articles on REP. We identified 14 articles (all case reports) but selected only 12 because of unavailable data in the other 2 articles. We also report the case of an REP which was misdiagnosed as ectopic choriocarcinoma. The 33-year-old woman was admitted via the outpatient department with a history of 54 days of amenorrhea and persistent elevated serum β-human chorionic gonadotropin (hCG) levels.The presumed diagnosis ectopic choriocarcinoma was made based on imaging findings. Single-drug chemotherapy with methotrexate (MTX; 20-mg intramuscular injection daily for 5 consecutive days) was administered. An upper abdominal mass was noticed by the patient and laparotomy was performed. A retroperitoneal pregnant lesion was found and removed successfully. The diagnosis, treatment and mechanisms of REP are discussed. We believe REP should be considered in patients with elevated serum β-hCG levels when the uterus and adnexa appear to be normal. Systemic administration of MTX in nonruptured REP before operation may prove to be helpful.

Background In recent years, total hip arthroplasty via the direct anterior approach (DAA) has become more common. Little is known on the influence of the surgical approach on the microbiological spectrum and resistance pattern in periprosthetic hip joint infections. The aim of the present study was to evaluate the microbiological spectrum and resistance pattern in periprosthetic hip joint infections comparing the direct anterior versus lateral approach in a matched-cohort analysis at a single institution. Methods Patients who underwent revision hip arthroplasty due to PJI following primary total hip arthroplasty with culture positive microbiology were analyzed. In all study patients, both the primary surgery and the revisions surgery were performed at the same institution. Only patients in whom primary surgery was performed via a direct anterior or lateral approach were included (n = 87). A matched cohort analysis was performed to compare the microbiological spectrum and resistance pattern in PJI following direct anterior (n = 36) versus lateral (n = 36) primary THA. Results We identified both a significantly different microbiological spectrum and resistance pattern in PJI comparing direct anterior versus lateral approach THA. Cutibacterium avidum was obtained more frequently in the anterior subgroup (22.2% vs. 2.8%, p = 0.028). In the subgroup of infections with Staphylococcus aureus (n = 12), methicillin resistance was detected in 3/5 cases in the direct anterior group versus 0/7 cases in the lateral group (p = 0.045). Overall, Staphylococcus epidermidis was the most common causative microorganism in both groups (direct anterior: 36.1%; lateral: 27.8%, p = 0.448). Conclusion The present study indicates a potential influence of the localization of the skin incision in THA on the microbiological spectrum and resistance pattern in PJI. Cutibacterium avidum seemed to be a more common causative microorganism in PJI in patients who underwent direct anterior compared to lateral approach THA.

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