A Case of Successful Laparoscopic Surgery for Tubal Stump Pregnancy after Tubectomy

Abstract

The incidence of ectopic pregnancy is approximately 1.3–2% of all pregnancies, and more than 90% of ectopic pregnancies are detected in the ampulla of the fallopian tube. Ectopic pregnancy occurring in tubal stump after tubectomy is extremely rare, and the frequency of tubal stump pregnancy is approximately 0.4% of all pregnancies. We report one of these rare cases of ectopic pregnancy in a 26-year-old Japanese woman, gravida 4, parity 1. She had undergone laparoscopic tubectomy because of a tubal pregnancy two years ago. She was presented to our hospital with a positive pregnancy test, but no gestational sac was detected in the uterus by echography, even though the level of human chorionic gonadotropin (hCG) in the blood was elevated to 8,900 mIU/mL. Laparoscopic surgery for ectopic pregnancy was performed. During surgery, the position of the pregnancy was found to be in the tubal stump, where tubectomy had already been performed, and the gestational sac was successfully removed. After the surgery, the condition of the patient uneventfully improved and she was discharged from the hospital three days after the surgery. The diagnosis of tubal stump pregnancy is more difficult than that of the more common positions of an ectopic pregnancy in the fallopian tube, and so it is more important to carefully examine the patients with suspected ectopic pregnancy. Laparoscopic surgery is one of the options for tubal stump pregnancy if diagnosed early and if the condition of the patient is stable.

Laparoscopic Management of 42 Cases of Tubal Stump Pregnancy and Postoperative Reproductive Outcomes

“…Laparoscopic surgery for tubal stump pregnancy is more challenging compared with common laparoscopic tubectomy because of the unique anatomic location, making the determination of appropriate operative method dependent on surgeon preference and expertise. There are several reports of successful laparoscopic operations for tubal stump pregnancy using an advanced bipolar device sutured with absorbable polyglactin [10,17]. In the current study, after the gestational sac was removed via laparoscopic cornuostomy using grasping forceps, the uterine incision was repaired with a single-layer, continuous 1-0 polyglactin suture with minimal use of diathermy.…”

“…The operative method for tubal stump pregnancy is almost the same as to that for interstitial pregnancy [8,9]. A case of successful laparoscopic surgery for tubal stump pregnancy after tubectomy has been reported [10]. However, little is known about future fertility and pregnancy outcomes following laparoscopic operations for tubal stump pregnancies.…”

Pregnancy outcomes in patients with tubal infertility following laparoscopic treatment: a multivariate predictive study

“…Therefore, it allows the clinician to clearly diagnose pelvic diseases and assess the status of the fallopian tubes for particular treatment. Laparoscopic treatment has been shown to be the most effective method of restoring the natural physiological state and function of the fallopian tubes (9). Laparoscopy has the advantages of less trauma, faster recovery, and reduced postoperative complications (10).…”

Use of placenta cryoextract for restoring the morphofunctional state of reproductive organs in animals with syndrome of premature ovarian insufficiency. Experimental substantiation

“…Частота позаматкової вагітності в країнах Європи становить 0,2-2,4% від усіх вагітностей, тоді як в Україні -15,4 на 1000 вагітностей, а співвідношення маткової та ектопічної вагітності -1:100. При цьому трубна вагітність становить 93-98,5% у структурі позаматкової вагітності [1][2][3][4][5]. У 14,5-27,3% хворих із позаматковою вагітністю проводиться терапія метотрексатом, у 78,4% пацієнток -хірургічне лікування [6][7][8][9].…”