Successful Treatment of a Pararenal Pregnancy Using High-Dose Methotrexate Regimen: A Case Report.

BACKGROUND

Upper abdominal pregnancy is rare. Most patients present with hemoperitoneum, requiring emergency laparotomy.

CASE

A 32-year-old woman presented with acute abdominal pain and an elevated beta-human chorionic gonadotropin (β-hCG) level. Ultrasound, computerized tomography (CT) scans, and laparoscopy failed to locate the source of elevated hCG. Subsequent positron emission tomography (PET)-CT demonstrated a cystic mass in the left pararenal region with no increased uptake. Repeated ultrasound scan revealed a live fetus implanted laterally to the abdominal aorta. After failing to respond to methotrexate at the usual dosage, a regimen used in gestational trophoblastic neoplasia was given. The pregnancy underwent miscarriage afterwards, and the hCG level gradually returned to normal.

CONCLUSION

The site of an ectopic pregnancy should be sought thoroughly to avoid missing an abdominal pregnancy and hence disastrous hemoperitoneum. While medical therapy with high-dose methotrexate is not a standard treatment, it can be considered after failing the traditional therapy, provided that there is adequate treatment monitoring and expertise in handling the side effects of the medication.