Elshatby Bassant, Belal Mohamed Mohamed, Rezk Mohamed Emad
ElShatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
J Med Case Rep. 2024 Dec 31;18(1):644. doi: 10.1186/s13256-024-04893-6.
Ectopic pregnancy, occurring outside the uterine cavity, poses a significant health risk, with Fallopian tube involvement being predominant. Recurrent ectopic pregnancy, particularly in the ipsilateral remnant of a previously removed tube, is a rare and poorly understood phenomenon. Here, we present a case of recurrent ectopic pregnancy occurring in the distal remnant of the right fallopian tube following ipsilateral incomplete salpingectomy in a 22-year-old woman.
A 22-year-old woman of mixed Arab ancestry and African ethnicity, gravida 4, para 1, with a history of one miscarriage and a previous ectopic pregnancy, presented to Elshatby Maternity Hospital, Alexandria, Egypt, complaining of severe lower abdominal pain with a history of an open right salpingectomy one year prior due to the ectopic pregnancy. She exhibited stable vital signs on admission. Ultrasound revealed a 6-week gestational sac in the right fallopian tube, accompanied by hematoma and mild pelvic collection. Despite analgesic interventions, her symptoms worsened the next day, prompting open surgery. Surprisingly, the distal portion of the right tube, which was supposed to have been removed in the prior salpingectomy, contained the ectopic pregnancy. A laparotomy was performed, involving evacuation of the pelvic hematoma, distal ipsilateral tubal salpingectomy, and peritoneal lavage. Postoperative recovery was uneventful, with improvement demonstrated during follow-up.
Caution should be taken when dealing with any woman in the reproductive age group who presents with acute abdomen, especially if she has a previous history of ectopic pregnancy, to exclude the possibility of recurrent ectopic pregnancy. Previous salpingectomy does not exclude the possibility of recurrent ectopic pregnancy on the ipsilateral side, as the inappropriate surgical technique used during salpingectomy can affect the possibility of recurrence. We suggest that careful clinical consideration of the surgical technique used during salpingectomy is essential to minimize the risk of recurrent ectopic pregnancies and prevent serious complications.
宫外孕发生在子宫腔外，会带来重大健康风险，其中输卵管受累最为常见。复发性宫外孕，尤其是发生在先前切除输卵管的同侧残端，是一种罕见且了解甚少的现象。在此，我们报告一例22岁女性在同侧输卵管不完全切除术后，右侧输卵管远端残端发生复发性宫外孕的病例。
一名22岁、具有阿拉伯和非洲混血血统的女性，孕4产1，有一次流产和一次宫外孕病史，因宫外孕于一年前在埃及亚历山大的埃尔沙特比妇产医院接受了右侧输卵管切除术，现因严重下腹痛前来就诊。入院时生命体征稳定。超声检查发现右侧输卵管内有一个6周大小的妊娠囊，伴有血肿和轻度盆腔积液。尽管采取了止痛措施，但第二天她的症状仍加重，于是进行了开腹手术。令人惊讶的是，本应在先前输卵管切除术中已被切除的右侧输卵管远端部分却存在宫外孕。进行了剖腹探查术，包括清除盆腔血肿、同侧输卵管远端切除术和腹腔灌洗。术后恢复顺利，随访期间病情有所改善。
对于任何出现急腹症的育龄期女性，尤其是有宫外孕病史的女性，应谨慎排除复发性宫外孕的可能性。先前的输卵管切除术并不能排除同侧复发性宫外孕的可能性，因为输卵管切除术中使用的不当手术技术可能会影响复发的可能性。我们建议，在输卵管切除术中仔细考虑所使用的手术技术对于将复发性宫外孕的风险降至最低并预防严重并发症至关重要。
