Persistent ectopic syndrome: a case report and literature review

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Clinical Case Reports

Background:

• Ectopic pregnancy, particularly ampullary, presents diagnostic and therapeutic challenges.
• Conservative management like salpingostomy aims to preserve fertility but risks incomplete treatment.
• Persistence of trophoblastic tissue is a known complication requiring vigilant follow-up.

Observation:

• A case of ampullary ectopic pregnancy treated with salpingostomy experienced persistent trophoblastic tissue.
• Repeat surgery was required 26 days later to remove residual trophoblastic tissue.
• Literature review identified nine reported cases, with eight requiring a second operation for persistent trophoblastic tissue.

Findings:

• In four cases with available data, human chorionic gonadotropin (hCG) titers were positive preoperatively and negative postoperatively after the second procedure.
• Trophoblastic tissue was recovered in eight out of nine reported cases during repeat operations.
• The disappearance curve of hCG after ectopic gestation excision is a critical indicator.

Implications:

• A single beta-human chorionic gonadotropin (beta-hCG) measurement two weeks after conservative ectopic pregnancy treatment is recommended.
• This monitoring strategy aids in early detection of persistent trophoblastic tissue.
• Timely intervention can prevent complications associated with retained ectopic pregnancy tissue.