Extratubal secondary trophoblastic implants (ESTI) following laparoscopic bilateral salpingectomy for ectopic pregnancy: problems that have been neglected for a long time

Abstract

Background: Extratubal secondary trophoblastic implants following laparoscopic salpingectomy is an extremely rare form of persistent ectopic pregnancy. These cases usually result in a small amount of vaginal bleeding and sudden lower abdominal pain thereby presenting with hemoperitoneum in emergencies. Owing to the urgency of hemoperitoneum and the uncertainty of the location of persistent ectopic pregnancy after laparoscopic salpingectomy, the risk of reoperation is increased. It is necessary to prevent in first surgery and diagnose these cases in the early following up phase.Methods: We report a case of 26-year-old woman, gravida 3, para 0, presenting a little vaginal bleeding and slight lower abdominal pain after laparoscopic bilateral salpingectomy for more than 1 month. The patient's serum β-HCG was still high (3981 mIU/ml), and no abnormalities were found through auxiliary examination (ultrasound, abdominal CT, and pelvic MRI).Results: Finally, emergency laparoscopy revealed many blue purple nodules on the surface of ovaries, small intestine, omentum, and periumbilical peritoneum, with a diameter of 3-20 mm. The lesions were completely removed as far as possible. Pathology showed trophoblastic proliferation and β-HCG soon decreased to negative after this operation.Conclusion: Therefore, it is important to follow up serum β-HCG even after salpingectomy and avoid iatrogenic dissemination of trophoblast tissue through careful operation.

Keywords: Extratubal secondary trophoblastic implants; ectopic pregnancy; human chorionic gonadotropin; laparoscopic salpingectomy; methotrexate; 人绒毛膜促性腺激素; 异位妊娠;腹腔镜输卵管切除术; 甲氨蝶呤; 输卵管外继发滋养细胞植入物.