Abstract
An unusual case of retroperitoneal ectopic pregnancy is reported. The patient, a 34 year old nulligravida, underwent IVF/ET following bilateral salpingectomy. A small, degenerating, intrauterine gestational sac suggested failing intrauterine pregnancy. There was no intraperitoneal free fluid. On Day 41 after ET, the patient was hospitalized because of acute epigastric pains. A pseudocyst of the head of pancreas was demonstrated by CT scan. A day later, exploratory laparotomy, because of a precipitous drop in the hemoglobin, revealed a massive retroperitoneal hematoma and an embryo in the gestational sac attached to the head of pancreas and major blood vessels. The patient did well following surgery. The mechanisms of retroperitoneal embryo migration are discussed and literature is reviewed.
Keywords: Ectopic pregnancy, IVF, bilateral salpingectomy, retroperitoneal upper abdominal pregnancy
Full Text
The Full Text of this article is available as a PDF (187.2 KB).
Footnotes
Private practice
REFERENCES
- 1.Assisted reproductive technology in the United States: 1997 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. Fertil Steril 2000;74:641–653 [DOI] [PubMed]
- 2.Yovich JL, Turner SR, Murphy AJ. Embryo transfer technique as a cause of ectopic pregnancies in in-vitro fertilization. Fertil Steril. 1985;44:318–321. doi: 10.1016/s0015-0282(16)48854-0. [DOI] [PubMed] [Google Scholar]
- 3.Strandell A, Thorburn J, Hamberger L. Risk factors for ectopic pregnancy in assisted reproduction. Fertil Steril. 1999;71:282–286. doi: 10.1016/s0015-0282(98)00441-5. [DOI] [PubMed] [Google Scholar]
- 4.Ferland RJ, Chadwick DA, O’Brien JA, Granai CO., III An ectopic pregnancy in the upper retroperitoneum following in-vitro fertilization and embryo transfer. Obstet Gynecol. 1991;3:544–546. [PubMed] [Google Scholar]
- 5.Cohen J, Alikani M, Trowbridge J, Rosenwaks Z. Implantation enhancement by selective assisted hatching using zona drilling of human embryos with poor prognosis. Hum Reprod. 1992;7:685–691. doi: 10.1093/oxfordjournals.humrep.a137720. [DOI] [PubMed] [Google Scholar]
- 6.Mukherjee T, Copperman AB, McCaffrey C, Cook CA, Bustillo M, Obasaju MF. Hydrosalpinx fluid has embryotoxic effects on murine embryogenesis:Acase for prophylactic salpingectomy. Fertil Steril. 1996;66:851–853. doi: 10.1016/s0015-0282(16)58652-x. [DOI] [PubMed] [Google Scholar]
- 7.Surrey ES, Schoolcraft WB. Laparoscopic management of hydrosalpinges before in-vitro fertilization-embryo transfer: Salpingectomy versus proximal tubal occlusion. Fertil Steril. 2001;75:612–617. doi: 10.1016/s0015-0282(00)01742-8. [DOI] [PubMed] [Google Scholar]
- 8.Agrawal SK, Wisot AL, Garzo G, Meldrum DR. Cornual pregnancies in patients with prior salpingectomy undergoing in-vitro fertilization and embryo transfer. Fertil Steril. 1996;65:659–660. doi: 10.1016/s0015-0282(16)58171-0. [DOI] [PubMed] [Google Scholar]
- 9.Fisch B, Peled Y, Kaplan B, Zehavi S, Neri A. Abdominal pregnancy following in-vitro fertilization in a patient with previous bilateral salpingectomy. Obstet Gynecol. 1996;88:643–644. doi: 10.1016/0029-7844(96)00213-x. [DOI] [PubMed] [Google Scholar]
- 10.Atrash HK, Friede A, Hogue CJR. Abdominal pregnancy in the United States: Frequency and maternal mortality. Obstet Gynecol. 1987;69:333. [PubMed] [Google Scholar]
- 11.Horn LC, Bilek K. Clinicopathologic analysis of gestational trophoblastic disease: Report of 158 cases. Gen Diagn Pathol. 1997;143:173–178. [PubMed] [Google Scholar]
- 12.Yabushita H, Shimazu M, Yamada H, Sawaguchi K, Noguchi M, Nakanishi M, Kawai M. Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer. Gynecol Oncol. 2001;80:139–144. doi: 10.1006/gyno.2000.6067. [DOI] [PubMed] [Google Scholar]