Chronic Pelvic Pain Due to Residual Ectopic Tissue After Treatment With Methotrexate.

Ectopic pregnancy is a medical emergency that requires prompt treatment. Treatment options include either medical management with methotrexate or surgical management. There are several risks associated with methotrexate therapy. However, chronic pelvic pain is typically not a risk cited. The case presented is a 27-year-old Hispanic woman, gravida two, para zero with chronic pelvic pain and a history of left tubal ectopic pregnancy successfully treated with methotrexate. Pelvic ultrasound demonstrated a hemorrhagic structure adjacent to the left ovary suspicious for residual ectopic pregnancy tissue. After a period of conservative management, the patient elected for surgical management via laparoscopic left salpingectomy. Pathologic analysis of the specimen confirmed a hyalinized nodule with chronic inflammation, suggestive of remote treatment of ectopic pregnancy. Post-operatively, the patient's chronic pelvic pain completely resolved. Further research needs to be done on the incidence of chronic pelvic pain following methotrexate treatment for ectopic pregnancy.