Interstitial pregnancy is one of the most serious and uncommon ectopic pregnancies: Case report.
Ectopic pregnancy
Hemorrhagic emergency
Interstitial pregnancy
Journal
International journal of surgery case reports
ISSN: 2210-2612
Titre abrégé: Int J Surg Case Rep
Pays: Netherlands
ID NLM: 101529872
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
15
03
2022
revised:
08
05
2022
accepted:
10
05
2022
pubmed:
25
5
2022
medline:
25
5
2022
entrez:
24
5
2022
Statut:
ppublish
Résumé
Ectopic pregnancies are a dreaded and common cause of first-trimester metrorrhagia. They refer to the implantation and development of the embryo outside the uterine cavity. Interstitial localization is uncommon and corresponds to implantation of the embryo in the intramural part of the uterine tube. It has an unforeseen evolution with a risk of cataclysmic hemorrhage by uterine rupture in the absence of early diagnosis and management. We herein present the uncommon case of a 26-year-old female patient, second gestation, nulliparous, who underwent a pelvic ultrasonography in the emergency department for pelvic pain associated with a two-month amenorrhea. A past history of left salpingectomy for a ruptured tubal ectopic pregnancy 3 years ago was found. Pelvic ultrasound allowed us to detect a ruptured ectopic interstitial pregnancy at 7 weeks of amenorrhea. Significant hemoperitoneum and hemodynamic instability required emergency laparotomy. The condition was confirmed preoperatively and the patient underwent a corneal resection. The postoperative course was uneventful and the patient was discharged on day 4 postoperatively. The interstitial ectopic pregnancy is an uncommon and life-threatening condition. The importance of early ultrasound detection is of paramount importance to allow conservative treatment with methotrexate injections. Delayed diagnosis requires cornual uterine resection with all the complications that it implies.
Sections du résumé
BACKGROUND
BACKGROUND
Ectopic pregnancies are a dreaded and common cause of first-trimester metrorrhagia. They refer to the implantation and development of the embryo outside the uterine cavity. Interstitial localization is uncommon and corresponds to implantation of the embryo in the intramural part of the uterine tube. It has an unforeseen evolution with a risk of cataclysmic hemorrhage by uterine rupture in the absence of early diagnosis and management.
CASE PRESENTATION
METHODS
We herein present the uncommon case of a 26-year-old female patient, second gestation, nulliparous, who underwent a pelvic ultrasonography in the emergency department for pelvic pain associated with a two-month amenorrhea. A past history of left salpingectomy for a ruptured tubal ectopic pregnancy 3 years ago was found. Pelvic ultrasound allowed us to detect a ruptured ectopic interstitial pregnancy at 7 weeks of amenorrhea. Significant hemoperitoneum and hemodynamic instability required emergency laparotomy. The condition was confirmed preoperatively and the patient underwent a corneal resection. The postoperative course was uneventful and the patient was discharged on day 4 postoperatively.
CONCLUSIONS
CONCLUSIONS
The interstitial ectopic pregnancy is an uncommon and life-threatening condition. The importance of early ultrasound detection is of paramount importance to allow conservative treatment with methotrexate injections. Delayed diagnosis requires cornual uterine resection with all the complications that it implies.
Identifiants
pubmed: 35609475
pii: S2210-2612(22)00441-2
doi: 10.1016/j.ijscr.2022.107195
pmc: PMC9126789
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
107195Informations de copyright
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Références
J Obstet Gynaecol Can. 2021 May;43(5):614-630.e1
pubmed: 33453378
Obstet Gynecol. 2004 Jan;103(1):47-50
pubmed: 14704243
Taiwan J Obstet Gynecol. 2021 Jan;60(1):173-176
pubmed: 33494997
Int J Gynaecol Obstet. 1998 Mar;60(3):279-82
pubmed: 9544713
Eur J Obstet Gynecol Reprod Biol. 1996 Dec 27;70(2):151-6
pubmed: 9119095
Hum Reprod. 2002 Dec;17(12):3224-30
pubmed: 12456628
Int J Surg. 2020 Dec;84:226-230
pubmed: 33181358
Lancet. 1998 Apr 11;351(9109):1115-20
pubmed: 9660597
Obstet Gynecol. 1981 Aug;58(2):167-75
pubmed: 7254728
Cureus. 2021 Nov 5;13(11):e19280
pubmed: 34877222
Hum Reprod. 1998 Jul;13(7):1981-6
pubmed: 9740461
Fertil Steril. 1982 Jun;37(6):851-2
pubmed: 7084507
Hum Reprod. 1995 Jul;10(7):1864-5
pubmed: 8582999
Am J Obstet Gynecol. 1953 Dec;66(6):1271-9
pubmed: 13104529
Gynecol Obstet Invest. 1993;35(4):243-4
pubmed: 7687231
J Gynecol Obstet Biol Reprod (Paris). 2003 Nov;32(7 Suppl):S93-100
pubmed: 14699323
Case Rep Obstet Gynecol. 2020 Jun 16;2020:2417428
pubmed: 32607264