[Persistent ectopic pregnancy. Peritoneal-uterine late implantation. Case report]

We report a case of a 31 years-old female previously treated with laparoscopic salpingectomy due to fimbrial ectopic unruptured pregnancy. After 33 days it was performed a repeated laparoscopy due to persistent b-hCG levels and abdominal pain. During surgical performance there were located three ectopic implantations (one uterine and two peritoneal) of active trophoblastic cells with intermittent bleeding. Fulguration with bipolar current was practiced and administered an intramuscular dose of methotrexate. b-hCG monitoring curve descend until it was negative ten days later. In spite of skillful technique and careful review of pelvic cavity there still are active throphoblastic cells that may cause surgical urgency. Supplementary therapy with a single dose of methotrexate can be an innocuous option.