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.

摘要

背景：腹腔镜输卵管切除术后输卵管外二次滋养细胞植入物是一种极为罕见的持续性异位妊娠。这些病例通常会导致少量阴道出血和突然的下腹痛, 从而在紧急情况下出现腹腔积血。由于腹腔镜输卵管切除术后腹腔积血的紧迫性和持续异位妊娠位置的不确定性, 增加了再次手术的风险。有必要在第一次手术中预防并在早期随访阶段诊断这些病例。

方法：报告1例26岁女性, 妊娠3, 0段, 腹腔镜双侧输卵管切除术后1个月多, 出现阴道少量出血, 下腹轻微疼痛。患者血清b-HCG仍偏高（3981 mIU/ml）, 辅助检查（超声、腹部CT、盆腔MRI）未见异常。

结果：最后急诊腹腔镜检查发现卵巢、小肠、网膜、脐周腹膜表面有许多蓝紫色结节, 直径3～20mm。尽可能将病变完全切除。术后病理示滋养细胞增殖, b-HCG很快下降为阴性。

结论：因此, 即使在输卵管切除术后, 仍需随访血清b-HCG, 并通过谨慎操作避免滋养层组织的医源性播散。

Keywords:

• Extratubal secondary trophoblastic implants
• ectopic pregnancy
• laparoscopic salpingectomy
• methotrexate
• human chorionic gonadotropin

关键词:

• 输卵管外继发滋养细胞植入物
• 异位妊娠;腹腔镜输卵管切除术
• 甲氨蝶呤
• 人绒毛膜促性腺激素

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the Department of gynecology and obstetrics affiliated to Fudan University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author contributions

Ting Wang performed the data analyses and wrote the manuscript. Qin Li contributed to the conception of the study.

Disclosure statement

Ting Wang declares that she has no conflict of interest. Qin Li declares that she has no conflict of interest.

Funding

The author(s) reported there is no funding associated with the work featured in this article.