Ectopic pregnancy after hysterectomy may not be so uncommon: A case report and review of the literature

Abstract

BackgroundEctopic pregnancy after hysterectomy is a very uncommon event, but its frequency is increasing. Since first reported by Wendler in 1895, 71 cases of post-hysterectomy have been reported.CaseA woman, 2 years after an abdominal supracervical hysterectomy, presented with a ruptured fallopian tube ectopic pregnancy.ConclusionAny woman, even after hysterectomy but with ovaries in situ, who presents with an acute abdomen or abdominal–pelvic pain should be screened for pregnancy.

A systematic review of ectopic pregnancy after hysterectomy

“…The majority of ectopic pregnancies, including early and late cases, occurred following a vaginal hysterectomy (Table ). This could be attributable to the surgical techniques used during vaginal hysterectomy, whereby adnexal structures are brought into close proximity with the vaginal cuff and the fallopian tube pedicle can inadvertently become incorporated into the peritoneal closure . This would result in a prolapsed fallopian tube, which could provide a conduit for sperm to travel through.…”

“…Fistula formation might also be more common with vaginal hysterectomy. Possible contributing factors include an open vaginal‐cuff closure technique, a vaginal‐cuff infection or hematoma, and the formation of granulation tissue . Although this is only speculative, vaginal hysterectomy could carry an increased risk of a late ectopic pregnancy after hysterectomy .…”

“…Possible contributing factors include an open vaginal‐cuff closure technique, a vaginal‐cuff infection or hematoma, and the formation of granulation tissue . Although this is only speculative, vaginal hysterectomy could carry an increased risk of a late ectopic pregnancy after hysterectomy . Changes in the frequency with which the various types of hysterectomy are performed could partly explain the association of posthysterectomy ectopic pregnancy with vaginal hysterectomy; however, this is difficult to assess because of the changes in practice over the past century…”

“…Cervical remnants that remain after a hysterectomy could also lead to fistula formation. It is possible that re‐epithelialization before complete closure can lead to a fistula between the vaginal canal and the peritoneal cavity . A case of an uncomplicated supracervical hysterectomy leading to an ectopic pregnancy after hysterectomy showed a pinhole, fistulous tract seen in the cervical stump at the time of surgery .…”

“…Alterations to surgical methods have been suggested to reduce the probability of this occurring. In particular, incorporation of the adnexal structures into the vaginal cuff should be avoided . When performing a supracervical hysterectomy, an attempt should be made to obliterate the residual cervical canal to prevent re‐epithelialization and fistula formation .…”