OBJECTIVE
Demonstrate retroperitoneal ectopic pregnancy (REP)[1,2] occurs when implantation happens in the retroperitoneal space.
Design
Laparoscopic treatment in case 1.
Laparoscopic treat with MTX adjuvant treatment.
Patients
The first case presented with abdominal pain and high serum beta-human chorionic gonadotrophin (BhCG). Laparoscopy showed a bleeding peritoneal defect which was excised and serum BhCG normalized thereafter [Figure 1].
Figure 1.
(a) Pelvic ultrasonography of left adnexal mass with a 1.7 cm × 1.0 cm × 1.6 cm cystic focus and thick echogenic rim. (b) Intraoperative photograph of retroperitoneal ectopic pregnancy lateral to the left uterosacral ligament. (c) Histopathology images (from left to right). (i) Crushed fibrofatty tissue with endometrial gland and surrounding stroma in keeping with endometrioisis. (ii) Collections of trophoblastic cells admixed with blood and fibrin. (iii) Immunohistochemistry for GATA 3 highlights the trophoblastic cells
The second case presented similarly. Laparoscopy was negative but follow up BhCG continued rising. Evacuation of the uterus was done with no products of conception seen. Intramuscular methotrexate was given twice with declining BhCG. However, patient presented with pain requiring laparoscopy. Intraoperatively, an ectopic pregnancy implanted in the peritoneal defect was removed and serum BhCG dropped thereafter [Figure 2].
Figure 2.
Ultrasound and intraoperative image of Case 2. Retrospective review of intraoperative image from first diagnostic laparoscopy (Right below)
Interventions
Laparoscopy showed oozing from a peritoneum defect lateral to left uterosacral ligament which was excised. After laparoscopy was negative medical treat was give with Intramuscular methotrexate (IM MTX).
RESULTS
Both of this 2 cases post-remission laparoscopic is without adjuvant therapy.
CONCLUSION
Peritoneal survey during negative laparoscopy in common endometriotic sites is critical, especially in the presence of endometriotic peritoneal defects.[3,4] Surgical excision allows for histology, but risks damage to adjacent organs. Alternatives include local or systemic MTX,[5,6](Case 2) or conservative management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Supplementary material
Supplementary material associated with this article be found in the online version at http://www.apagemit.com/page/video/show.aspx?num=263&page=1.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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