Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.
Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei city, Taiwan.
Taiwan J Obstet Gynecol. 2024 Jul;63(4):557-560. doi: 10.1016/j.tjog.2024.04.010.
Chronic ectopic pregnancy is a variant of ectopic pregnancy featured with a low or normal serum beta-human chorionic gonadotropin (β-hCG) test. Obscure clinical presentations and non-specific images make chronic ectopic pregnancy a diagnostic dilemma until now.
A 40-year-old female was misdiagnosed as tubo-ovarian abscess initially due to chronic lower abdominal pain, negative pregnancy test, and a complicated pelvic mass on abdominal CT scan and serial follow-up ultrasonography. Diagnostic laparoscopy was performed because of persistent pelvic mass with abdominal pain and irregular vaginal bleeding. Left tubal salpingectomy was performed and pathology reported a hematocele with inactive trophoblast tissue. Chronic ectopic pregnancy was proved. The symptoms resolved completely after our surgery.
An abnormal adnexal mass with a history of recent pregnancy could still be possible for chronic ectopic pregnancy even with a negative pregnancy test. Diagnostic laparoscopy and pathology confirmation could be helpful when the clinical manifestation is confusing.
慢性宫外孕是宫外孕的一种变异形式，其特征为血清β-人绒毛膜促性腺激素（β-hCG）检测值较低或正常。由于临床表现不明显且影像学表现不典型，慢性宫外孕至今仍是诊断难题。
一名 40 岁女性因慢性下腹痛、妊娠试验阴性以及腹部 CT 扫描和连续超声检查提示复杂盆腔肿块，最初被误诊为输卵管卵巢脓肿。由于持续性盆腔肿块伴腹痛和不规则阴道出血，行诊断性腹腔镜检查。行左侧输卵管切除术，术后病理报告为血肿伴不活跃的滋养层组织。证实为慢性宫外孕。手术后，患者症状完全缓解。
即使妊娠试验阴性，近期妊娠史伴附件区异常包块仍有可能为慢性宫外孕。当临床表现不明确时，诊断性腹腔镜检查和病理证实可能会有所帮助。
