Laparoscopic Management of Short-Interval Interstitial Pregnancy After Recent Tubal Ectopic: A Case Report [ID 2683561]

INTRODUCTION: A 24-year-old G6P2032 presents with interstitial pregnancy 3 months after ipsilateral laparoscopic salpingectomy for ruptured tubal ectopic pregnancy. This case report demonstrates the management of short-interval interstitial pregnancy after recent ipsilateral laparoscopic salpingectomy. METHODS: The patient initially presented with a right-sided ruptured tubal ectopic pregnancy. Salpingectomy was performed to completely remove the fallopian tube and desiccate it at the cornua, leaving no residual visible tubal remnants. The patient presented with ipsilateral interstitial pregnancy 3 months later and initially underwent systemic methotrexate injection, which failed to resolve the pregnancy. She then underwent laparoscopic cornuostomy and dilation and curettage (D&C). Cornuostomy was performed with injection of dilute vasopressin around the gestational sac to help minimize blood loss followed by hydrodissection and sharp dissection to remove the pregnancy. The myometrium and serosa were closed in layers. There was attention to preserve uterine myometrial tissue integrity at the cornua. The patient did well postoperatively and was discharged on postoperative day 0 (POD0). Her β-hCG trended from 11,902 mIU/mL pre-surgery to 7,726 on POD0, and 289 at 1 week. Pathology showed fragments of chorionic villi, and the D&C showed decidualized secretory endometrium. CONCLUSION: Short-interval interstitial ectopic pregnancies after prior salpingectomy for tubal ectopic are extremely rare. We demonstrated successful management with a minimally invasive laparoscopic cornuostomy after failed methotrexate. Patients should be counseled carefully about the risks of short-interval pregnancy after tubal ectopic even after care is taken to remove all visible portions of the fallopian tube.