Recurrent cornual ectopic pregnancies

Abstract

This report describes the management of a patient who developed two consecutive cornual ectopic pregnancies in a year preceded by two tubal ectopics on the same side. Interstitial pregnancy is a rare form of ectopic pregnancy with a significant mortality rate. It provides a challenge for clinicians both in their diagnosis and management. As yet, the incidence of recurrent cornual ectopic pregnancies is unknown. Currently conservative medical and surgical methods of management are favoured due to good outcomes and fewer risks. However, these methods do not protect against recurrence. In this report, we discuss the various methods of management described in literature.A 28-year-old woman was seen in the acute gynaecology emergency unit with a 3 days history of dysuria and lower abdominal and back pain. She had amenorrhoea for 5 and 1/2 weeks and had a positive pregnancy test. She was gravida 7 para 1+5. Her first pregnancy was an ectopic pregnancy which was managed in South Africa with a right partial salpingectomy. Her following three pregnancies were first trimester miscarriages and her last pregnancy was delivered at full term vaginally.She was haemodynamically stable. On abdominal examination, there was a marked tenderness in the right iliac fossa with guarding. Vaginal examination revealed cervical excitation and right adnexal tenderness but no bleeding. Transvaginal ultrasound showed a 24-mm mass in the right fornix, free fluid with a ground glass appearance in the pouch of Douglas and an empty uterus. An emergency laparoscopy was performed which diagnosed a ruptured ectopic pregnancy in the right tubal stump and a normal left tube and ovary (Fig. 1). A mini laparotomy and excision of the right tubal stump was carried out with good haemostasis. The patient recovered well and was discharged on the third day, post-operatively. Histology confirmed a right ruptured ectopic pregnancy.Three months later, the same patient presented to the acute gynaecology unit with a positive pregnancy test, 5 weeks amenorrhoea and constant dull aching lower abdominal pain. She was haemodynamically stable and on examination her abdomen was soft and non-tender and there was no cervical or adnexal tenderness on vaginal examination. Transvaginal ultrasound scan showed an 18-mm right-sided adenexal mass, free fluid in the pouch of Douglas and an empty uterus. A laparoscopy was performed, which showed that the patient was bleeding from a right cornual ectopic. The right cornual ectopic was removed laparoscopically with an endoloop and diathermy was performed for haemostasis (Fig. 2). The ectopic pregnancy sac was extruded during the procedure and sent for histology which confirmed products of conception. The post-operative BHCG was 2477 IU/L. The patient was followed up over the next 2 weeks with repeat BHCGs that Gynecol Surg (

Recurrent cornual pregnancy: a case report

“…4 Cornual ectopic pregnancy carries a significant mortality rate of 2-2.5% and accounts for 20% of all deaths due to ectopic pregnancies. 6 The successful vaginal delivery in this particular patient after undergoing laparoscopic resection of cornual ectopic demonstrates the ability of the myometrium to remodel and undergo physiological changes during a pregnancy in the same way as after a myomectomy or caesarean section. However, the risk of rupture, particularly during labour, remains high.…”

Cornual Ectopic Pregnancy in A Nigerian

“…Previous reports on their odd pregnancies were those of twin tubal pregnancy [11], and bilateral tubal pregnancies [12][13][14]. Elsewhere, the world's pattern was largely the same [1][2][3][4][5][6][7][8][9]. As regards cornual ectopic pregnancy itself, the local patient aged 30 years compares favorably with the 32 years of the Tunisian.…”

“…Cornual pregnancy is a rare variety of ectopic gestation that is located in the interstitial part of the fallopian tube. In this context, single case reports have come from India [1,2], Tunisia [3], Turkey [4,5], United Arab Republic [6], UK [7], and USA [8,9]. Accordingly, we report a classical case found among the Nigerian ethnic group called the Ibos [1][2][3][4][5][6][7][8][9][10].…”

Recurrent Interstitial Pregnancy: a Review of the Literature

“…Eleven out of 17 cases of recurrent interstitial pregnancy showed at least one pathology or anatomical anomaly in the uterotubal junction [1,2,5,11,14,16,19,20] (▶ Table 1). Furthermore, damaged tubes are found more frequently in proximal ectopic pregnancies than in distal ectopic pregnancies [3].…”