Case report: Robotically-treated spontaneous interstitial pregnancy on tubal stump

Abstract

To report a rare case of a right interstitial pregnancy spontaneously occurring in a patient who had previously undergone homolateral salpingo-oophorectomy, and to propose possible explanations for the mechanisms involved in the genesis of this rare scenario. A 32-year-old G3P1 female presented to our emergency room with symptoms related to a suspected ectopic interstitial pregnancy managed in another hospital using a conservative pharmacological approach. After discussing the risks, firstly she underwent a transvaginal ultrasound examination, then a diagnostic hysteroscopy to clarify the unclear ultrasound finding, followed by a successful robot-assisted laparoscopic cornual resection. Hysteroscopy demonstrated an empty uterine cavity, confirming the suspect of pregnancy localization into the interstitial portion of the tubal stump. Through the robot-assisted laparoscopic approach, all the trophoblastic tissue was removed without causing significant damage to the surrounding myometrium and preserving the patient's fertility. No post-operative complications were recorded. The robotic approach successfully allowed the cornual resection, with minimal blood loss and optimal suturing of the uterine defect. Although our knowledge is still limited, it is possible that the pregnancy nested in the tubal residue after being properly fertilized into the intact tube. However, it cannot be ruled out that there have been remodeling phenomena of the tubal residue so that it has acquired the ability to intercept the oocyte.

Keywords: case report; ectopic pregnancy; fertility; interstitial pregnancy; robotic surgery.

Figure 1

(A) Ultrasonographic finding. A 25×26 mm neoformation, with an intense peripheral vascularization in the right angular area suggesting an ectopic pregnancy; (B) Free fluid in the pouch of Douglas.

Figure 2

Diagnostic hysteroscopy shows an empty uterine cavity with visible tubal ostia.

Figure 3

(A) Robotic view of interstitial pregnancy; (B) Perilesional injection of 20 U of diluted vasopressin in 100 mL of normal saline solution; (C) Incision of the serosa and cleavage plan identification; (D) Pregnancy and surrounding myometrium resection; (E) Gestational sac; (F) Uterine wall repair with double-layer suture.

Figure 4

Summary of operating room timeline.