Laparoscopic management of an unruptured interstitial ectopic pregnancy following tubal recanalization: a case report emphasizing haemostatic and uterine reconstruction techniques

Abstract

Interstitial ectopic pregnancy is a rare and potentially life-threatening form of ectopic pregnancy because of the rich vascularity of the interstitial portion of the fallopian tube. Pregnancy following tubal recanalization carries a risk of ectopic implantation. We report a case of an unruptured interstitial ectopic pregnancy following bilateral tubal recanalization, managed successfully by laparoscopy. A 40-year-old G3P2L1 woman at 9 weeks of gestation presented with acute lower abdominal pain. Ultrasonography showed a left adnexal mass containing a live fetus with good cardiac activity. Laparoscopy revealed a 5×4 cm unruptured, highly vascular left interstitial pregnancy. Cornual wedge resection with left salpingectomy and uterine reconstruction was performed. Haemostatic control was achieved using dilute vasopressin and electrocautery, followed by multilayer closure of the myometrium and serosa. Estimated blood loss was 50 mL. Histopathology confirmed ectopic pregnancy and follow-up β-hCG was negative. Interstitial pregnancy requires early diagnosis because rupture can result in catastrophic haemorrhage. Careful laparoscopic surgery with effective haemostatic control and anatomical uterine reconstruction can provide definitive treatment in appropriately selected haemodynamically stable patients. A high index of suspicion is essential when pregnancy occurs following tubal recanalization. Prompt recognition and meticulous laparoscopic management can achieve effective haemostasis and preserve uterine integrity while avoiding major blood loss.