An ectopic pregnancy implanted between the leaves of the broad ligament is a challenge to diagnose and manage. It can be found in almost any week of pregnancy, and it can present with a great spectrum of symptoms. This makes it necessary for the clinician to keep a high level of alertness and suspicion for this uncommon diagnosis and to be prepared when treating any ectopic pregnancy with poor response to medical treatment. The broad ligament surrounds a number of anatomical structures, structures necessary to be preserved when removing the ectopic pregnancy. This can be a challenge for the surgeon, especially when the patient presents with severe symptoms and the pregnancy is advanced. In these cases, even hysterectomies have been reported, a severe operation especially when the patient is young and without having completed her family planning. Finally, in the last three decades with the increasing widespread of laparoscopy and the added experience, there is a growing effort to manage these ectopic pregnancies with minimally invasive procedures, offering the patient a faster recovery, minimum blood loss, and lower surgical morbidity.2 live birth. The rarity of these cases also makes it impossible to find extensive series of patients so as to determine the best treatment, making the clinician rely on previous case reports and the methods used in other treated cases.
AnatomyThe broad ligament of the uterus is a double-layer fold of peritoneum (anterior and posterior leaves) extending from each side of the uterus to the lateral pelvic walls and the pelvic floor. It covers the lateral uterine corpus and the upper cervix as well. The structures within the broad ligament (uterine tubes, ovarian artery, uterine artery, ovarian ligament, round ligament of the uterus, suspensory ligament of the ovary, ovary) are considered retroperitoneal. The broad ligament itself is composed of visceral and parietal peritonea that contain smooth muscle and connective tissue [4,5].
