Laparoscopic Treatment of A Chronic Ectopic Pregnancy

Α 32-year-old patient presented with moderate pain in the left hypogastrium and dyschezia. The serum β-hCG was <0.1mIU/mL, and ultrasonography showed a painful, inhomogenous mass beside the left ovary measuring 1.8×1.8×1.4cm. The uterine cavity was empty and the endometrium thin, while both ovaries seemed normal. The patient had a previous surgery for endometriosis three years earlier, a normal delivery one year ago and according to her gynecologist had suffered from an early spontaneous abortion one month ago where no dilatation and curettage was needed.

We prepared our patient for surgery initially suspecting deep infiltrating endometriosis of the left sacrouterine ligament. During laparoscopy, the unusual finding on the left pelvic side wall was surgically excised after adhesiolysis and histology confirmed the diagnosis of a chronic ectopic pregnancy on the ground of an endometriotic lesion. The postoperative course was uneventful.

Chronic ectopic pregnancy is a variant of ectopic pregnancy characterized by:

a pelvic mass containing necrotic gestational tissue, surrounded by adhesions, causing few symptoms and producing a low or absent serum hCG

Chronic ectopic pregnancy laparoscopy
The chronic ectopic pregnancy on the left pelvic side wall, surrounded by adhesions.
Laparoscopic treatment of the chronic ectopic pregnancy.

You can also watch the full video on youtube.

Bibliography

  • Tempfer, C. B., Dogan, A., Tischoff, I., Hilal, Z., & Rezniczek, G. A. (2019). Chronic ectopic pregnancy: case report and systematic review of the literature. Archives of gynecology and obstetrics300(3), 651–660. https://doi.org/10.1007/s00404-019-05240-7

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