Recurrent ectopic pregnancy in a remnant fallopian tube after ipsilateral salpingectomy is clinically rare. We report the extremely rare case of a third recurrent ectopic pregnancy after two previous salpingectomy procedures involving the opposite tube. A 26-year-old woman, gravida 3 para 0, experienced three ectopic pregnancies brought about by natural conception, all of which were treated surgically (right partial salpingectomy, right remnant tube resection, and left total salpingectomy). During the two salpingectomy procedures involving the right tube, the patency of the intact left tube was intraoperatively confirmed with indigo carmine. The most appropriate surgical intervention should be discussed when managing recurrent ectopic pregnancies. It might be necessary to perform total salpingectomy to reduce the risk of future recurrence on the remaining tube.
Ectopic pregnancies account for 1-2% of all pregnancies, and the rupturing of ectopic pregnancies can cause massive bleeding and maternal mortality [
A 26-year-old gravida 3, para 0 female was referred to our hospital at 6 + 5 weeks of gestation due to a suspicion of left tubal ectopic pregnancy. The patient’s medical history included one miscarriage and two ectopic pregnancies in the right tube, which had been surgically treated with right partial salpingectomy 4 years ago and right remnant salpingectomy 2 years ago, respectively. During these two ipsilateral salpingectomy procedures, normal left tubal patency was confirmed by chromotubation using indigo carmine. All of the pregnancies were established via natural conception, and during the first ectopic pregnancy the patient was diagnosed with a Chlamydia trachomatis infection. On admission, she was free from abdominal pain and vaginal discharge. Transvaginal ultrasonography revealed the absence of an intrauterine pregnancy and the presence of a left tubal ectopic pregnancy (a fetus and a fetal heartbeat were detected). The patient exhibited a serum
This report highlights an interesting clinical case of three surgically managed recurrent ectopic pregnancies brought about by natural conception, which were surgically treated with right partial salpingectomy, right resection of the remnant tube, and left total salpingectomy, respectively. The third tubal pregnancy occurred in the intact left tube, the patency of which was confirmed by chromotubation using indigo carmine during the previous two salpingectomy procedures.
To the best of our knowledge, this is the first report about a third surgically managed recurrent ectopic pregnancy in an intact tube after two salpingectomy procedures involving the opposite tube. Recurrent ectopic pregnancy in the remnant tube after ipsilateral salpingectomy is exceptionally rare [
The optimal management strategy for recurrent ectopic pregnancy was unclear. The risk of recurrent ectopic pregnancy is reported to be fourfold higher in cases involving previous medical or surgical management [
We described the first reported case of a third surgically managed recurrent ectopic pregnancy in an intact tube after two salpingectomy procedures involving the opposite tube. Obstetricians should be aware of the possibility of such rare cases, and the available surgical interventions should be fully discussed with patients when managing recurrent ectopic pregnancies. To avoid the risk of future recurrence in the remnant tube, it might be necessary to perform total salpingectomy rather than partial salpingectomy.
The authors declare that there is no conflict of interests regarding the publication of this paper.