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Case report: Robotically-treated spontaneous interstitial pregnancy on tubal stump
Mario Ascione1, Luigi Della Corte2, Giuseppe D'Angelo1
1Department of Public Health, University of Naples Federico II, Naples, Italy.
Frontiers in Medicine
|December 5, 2024
Summary
This case report details a rare right interstitial pregnancy in a patient with prior salpingo-oophorectomy. Robot-assisted surgery successfully removed the ectopic pregnancy, preserving fertility.
Area of Science:
- Reproductive Medicine
- Gynecologic Surgery
- Ectopic Pregnancy
Background:
- Interstitial pregnancies are rare, occurring within the intramural portion of the fallopian tube.
- Previous ipsilateral salpingo-oophorectomy (removal of the ovary and fallopian tube on the same side) further complicates the possibility of pregnancy in the remaining tubal stump.
Observation:
- A 32-year-old female presented with symptoms suggestive of an interstitial pregnancy after a previous homolateral salpingo-oophorectomy.
- Initial management at another hospital involved a conservative pharmacological approach.
- Transvaginal ultrasound and diagnostic hysteroscopy were performed to clarify the diagnosis.
Findings:
- Hysteroscopy confirmed an empty uterine cavity, indicating the pregnancy was located in the interstitial portion of the remaining tubal stump.
- Robot-assisted laparoscopic cornual resection was successfully performed to remove all trophoblastic tissue.
- The procedure preserved fertility with minimal damage to the myometrium and no post-operative complications.
Implications:
- This case highlights the possibility of spontaneous interstitial pregnancy even after homolateral salpingo-oophorectomy.
- Potential mechanisms include fertilization in the intact tube with subsequent migration to the tubal remnant or remodeling of the tubal stump allowing oocyte interception.
- Robot-assisted surgery offers a minimally invasive and effective approach for managing such rare ectopic pregnancies while preserving reproductive potential.
