Multidisciplinary treatment of retroperitoneal ectopic pregnancy: a case report and literature review

Abstract

Background Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 32 cases reported in the English literature. Early diagnosis of REP is very difficult and all treatments entail a high risk of life-threatening complications. Case presentation A 29-year-old nulliparous woman presented a history of 50-day amenorrhea and 7-day upper abdominal pain without vaginal spotting. The serum beta-human chorionic gonadotropin (β-hCG) value was 65,004 m-international units per milliliter (mIU/mL), but no intrauterine gestational sac was found via transvaginal sonography (TVS). Then transabdominal ultrasonography (TAS) and abdominal contrast-enhanced computer tomography (CT) identified a retroperitoneal ectopic pregnancy (REP) tightly adjacent to the inferior vena cava and the abdominal aorta. After consultation from a multidisciplinary team, systemic methotrexate (MTX, intramuscular 20 mg daily for 5 consecutive days) combined with ultrasound-guided local potassium chloride solution injection into the gestational sac was scheduled firstly for the patient. However, serum β-hCG continued to increase and the patient experienced worsening abdominal pain. Laparotomy was performed jointly by a gynecologist and a vascular surgeon. During the operation, the gestational sac with fetal bud measuring about 4.5 × 4.0x3.0 cm, tightly adherent to the surface of inferior vena cava and the left side of abdominal aorta, was carefully dissociated out from the surrounding tissues and removed en bloc. Histopathology examination confirmed the diagnosis of REP. The patient recovered uneventfully and her serum β-hCG returned to normal range on the 23th postoperative day. Conclusions Considering the possibility of REP and combined radiological examinations, such as ultrasonography and CT, are crucial for the early diagnosis of this rare condition. A multidisciplinary team is necessary to treat REP.

A Case Report of Retroperitoneal Ectopic Pregnancy After in vitro Fertilization-Embryo Transfer and Literature Review

“…Xu et al suggested that this may be related to higher β-HCG levels, more advanced gestations, and the presence of an ectopic viable embryo. 12 In addition, we found that five out of six blastocysts were localized near major blood vessels. In this regard, we speculate that the reason for the failure of drug therapy may be related to an insufficient drug concentration at the site of the lesion.…”

“…In addition, to avoid implantation failure, fertilized embryos are often placed deep within the cavity of uterine during ART implantation, thus increasing the likelihood of lymphatic metastasis. 12 Second, we found that more than 50% of REP patients with history of fallopian tube surgery, if a fistula forms between the tubal stump and the retroperitoneal space after salpingectomy, may result in direct communication between the uterine cavity and the retroperitoneum, thus making the spontaneous transfer of embryos from the uterine cavity to the retroperitoneum possible. 13 However, in this case, we found that although the right fallopian tube isthmus was present but attached to the surface of the broad ligament, the left fallopian tube was completely absent and no traces of fistula were found intraoperatively.…”

Minimally Invasive Management and Diagnosis of Ectopic Splenic Pregnancy

“…In situations of splenic or other abdominal pregnancy suspicion, an abdominal CT scan or MRI should be performed to evaluate the entire abdominal cavity [ 16 ]. CT and MRI scans are the most reliable in describing the relationship between the location of the gestational sac and surrounding tissue and in assessing the risk of rupture and other complications [ 16 , 17 ]. In our case, a CT scan was performed because the patient complained of diffuse abdominal pain, hemoglobin was low (86 g/L), and no pregnancy was observed in the uterus.…”

Unruptured ovarian ectopic pregnancy: Two case reports and literature review

“…Computed tomography (CT) examination, particularly enhanced CT examination, is important in the diagnosis of EPs at specific sites, such as hepatic ( Hu et al, 2014 ), omental ( Chen et al, 2015 ), and retroperitoneal pregnancies ( Xu et al, 2022 ). However, its application in detecting ovarian pregnancies is limited.…”