Tubal pregnancy four months after cauterisation of the vaginal vault: One year following a vaginal hysterectomy

A systematic review of ectopic pregnancy after hysterectomy

“…5 In the majority of cases, however, the differential diagnosis of a posthysterectomy ectopic pregnancy was so unexpected that clinicians did not consider it a possibility, and thus a β-hCG investigation was overlooked. The differential diagnoses considered included endometriosis, 24,25 a ruptured ovarian cyst, 26 an ovarian neoplasm, 5,27 as well as non-gynecologic causes including cholecystitis, 28 In the present review, surgical management occurred in all but one patient. The predominance of surgical treatment possibly reflects a lack of diagnostic certainty in these presentations, with a need to obtain a surgical specimen for a histologic diagnosis.…”

“…In the majority of cases, however, the differential diagnosis of a posthysterectomy ectopic pregnancy was so unexpected that clinicians did not consider it a possibility, and thus a β‐hCG investigation was overlooked. The differential diagnoses considered included endometriosis, a ruptured ovarian cyst, an ovarian neoplasm, as well as non‐gynecologic causes including cholecystitis, appendicitis, and ureteric colic . Often, the diagnosis of an ectopic pregnancy after hysterectomy was only made at the time of surgery or after histopathologic examination of the surgical specimen.…”

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

“…Ectopic pregnancy has been reported to occur as late as 12 years after hysterectomy, “late presentation,” and 42 such cases have now been reported [1] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , including this latest case treated by this author. This can only develop because the sperm have gained access to the peritoneal cavity through a fistulous tract between the vagina and the peritoneal cavity.…”

“…This can only develop because the sperm have gained access to the peritoneal cavity through a fistulous tract between the vagina and the peritoneal cavity. Although this has occurred after all types of hysterectomy, 50% follow vaginal hysterectomy [1] , [35] , [38] , [39] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [56] , [59] , [61] , [63] , [66] , and this would suggest a causal relationship. Although the operative narrative for the hysterectomy was seldom available to the physicians treating the ectopic pregnancy after hysterectomy, observations thought to increase the chance for vaginal-to-peritoneal fistula formation include an open vaginal cuff closure technique, vaginal cuff infection or hematoma formation after hysterectomy, vaginal cuff granulation tissue, and a prolapsed fallopian tube [51] , [52] , [53] , [54] , [55] , [56] , [59] .…”

“…Subtotal hysterectomy has increased in the United States in the past decade, estimated to now make up 7.5% of all hysterectomies performed [70] , [71] , [72] . Fourteen cases of “late presentation” ectopic pregnancy have followed supracervical or cesarean hysterectomy, including the current case [33] , [34] , [36] , [37] , [56] , [59] , [61] , [63] , [65] , [66] , [67] , [68] . Leaving a remnant of the cervix or the epithelialization of a much larger vaginal cuff closure area because of cervical dilation at the time of cesarean hysterectomy may increase fistulous tract formation [54] , [73] .…”