Tubal Stump Ectopic Pregnancy with Acute Abdomen: A Rare Case Report

Abstract

Abstract: Ectopic pregnancy is a serious condition in which the gestational sac settles outside the uterine cavity. Here we aim to present a case that underwent unilateral salpingectomy due to ectopic pregnancy five years ago and developed an ectopic pregnancy again in the remnant site of the same tube. Although tubal stump ectopic pregnancy is rarely seen in the literature, maternal mortality and morbidity rates are higher than for other tubal ectopic pregnancies. A woman's history of salpingectomy does not rule out ipsilateral recurrent ectopic pregnancy. This is also the first stump tubal ectopic pregnancy case presented from Turkey. Introduction: Ectopic pregnancy, which occurs in 1-2% of all pregnancies, is a leading cause of first-trimester maternal mortality. The incidence of ectopic pregnancy has increased due to factors such as maternal age, pelvic inflammatory disease, and assisted reproductive technology practices. Ipsilateral ectopic pregnancy in the tubal stump after salpingectomy is extremely rare and can cause diagnostic delay and life-threatening intraabdominal bleeding. Case Report: A 26-year-old patient with a history of laparoscopic right salpingectomy due to a ruptured right tubal ectopic pregnancy experienced another ectopic pregnancy in the remaining tube. Emergency laparotomy was performed due to hemorrhagic shock and suspected ruptured ectopic pregnancy. The ectopic pregnancy focus was excised, and the patient was discharged after three days without complications. Conclusion: Recurrent ectopic pregnancy in the remaining tubal stump after salpingectomy can have significant clinical consequences. Diagnosis is difficult, so clinicians should be vigilant, especially during early pregnancy in patients with a history of salpingectomy. Partial salpingectomy is not recommended for women of reproductive age, and all possible precautions should be taken to avoid delay in diagnosing tubal stump ectopic pregnancy and preventing its occurrence. References 1. Saraiya M, Berg CJ, Shulman H, Green CA, Atrash HK. Estimates of the annual number of clinically recognized pregnancies in the United States, 1981-1991. American journal of epidemiology. 1999;149(11):1025-9. 2. Ko PC, Liang CC, Lo TS, Huang HY. Six cases of tubal stump pregnancy: complication of assisted reproductive technology? Fertility and sterility. 2011;95(7):2432.e1-4. 3. Perkins KM, Boulet SL, Kissin DM, Jamieson DJ. Risk of ectopic pregnancy associated with assisted reproductive technology in the United States, 2001-2011. Obstetrics and gynecology. 2015;125(1):70-8. 4. Sun F, Yang S, Yang Y, Liu X, Xu H. Laparoscopic Management of 42 Cases of Tubal Stump Pregnancy and Postoperative Reproductive Outcomes. Journal of minimally invasive gynecology. 2020;27(3):618-24. 5. Samiei-Sarir B, Diehm C. Recurrent ectopic pregnancy in the tubal remnant after salpingectomy. Case reports in obstetrics and gynecology. 2013;2013:753269. 6. Sturlese E, Retto G, Palmara V, De Dominici R, Lo Re C, Santoro G. Ectopic pregnancy in tubal remnant stump after ipsilateral adnexectomy for cystic teratoma. Archives of gynecology and obstetrics. 2009;280(6):1015-7. 7. Takeda A, Manabe S, Mitsui T, Nakamura H. Spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after ipsilateral adnexectomy: report of two cases. The journal of obstetrics and gynaecology research. 2006;32(2):190-4. 8. Zuzarte R, Khong CC. Recurrent ectopic pregnancy following ipsilateral partial salpingectomy. Singapore medical journal. 2005;46(9):476-8. 9. Milingos DS, Black M, Bain C. Three surgically managed ipsilateral spontaneous ectopic pregnancies. Obstetrics and gynecology. 2008;112(2 Pt 2):458-9. 10. Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertility and sterility. 1999;72(2):207-15. 11. Peker N, Aydeniz EG, Gündoğan S, Şendağ F. Laparoscopic Management of Heterotopic Istmocornual Pregnancy: A Different Technique. Journal of minimally invasive gynecology. 2017;24(1):8-9. 12. Chien W-H, Liang C-CJGS. Repeated ectopic pregnancy on the tubal stump after laparoscopic salpingectomy. 2005;2(4):311-2. 13. Nishida M, Miyamoto Y, Kawano Y, Takebayashi K, Narahara H. A case of successful laparoscopic surgery for tubal stump pregnancy after tubectomy. Clinical medicine insights Case reports. 2015;8:1-4. 14. Gao MY, Zhu H, Zheng FY. Interstitial Pregnancy after Ipsilateral Salpingectomy: Analysis of 46 Cases and a Literature Review. Journal of minimally invasive gynecology. 2020;27(3):613-7. 15. McCausland A. Endosalpingosis ("endosalpingoblastosis") following laparoscopic tubal coagulation as an etiologic factor of ectopic pregnancy. American journal of obstetrics and gynecology. 1982;143(1):12-24.