Laparoscopic management of unruptured left ovarian ectopic pregnancy: a rare case report

Ovarian ectopic pregnancy (OEP), an uncommon and life-threatening condition, represents 0.5-3% of all ectopic pregnancies.

A 30-year-old lady (G5P2 + 1) presented with severe lower abdominal pain and tenesmus pain, off and on vaginal spotting, dyspareunia, fatigue, nausea, and vomiting. There was no history of abnormal vaginal bleeding, contraceptive use, or any systemic illness. Investigation found tenderness on the lower abdomen, and laboratory test showed a beta human chorionic gonadotropin (β-hCG) level of 2678 mIU/mL. There was an empty uterus and a left adnexal mass (45 × 44 mm) with a gestational sac corresponding to 7 weeks and 2 days, which showed no fetal heart activity, on a pelvic ultrasonogram. Laparoscopy revealed a left-sided ovarian cystic mass, followed by an exploration and a protective removal of a cyst with an ovarian cortex.

OEP is frequently misdiagnosed as other gynecologic diseases, which are dilemmas for preoperative diagnosis. Ultrasonography is necessary, but not sufficient, as the results do not differentiate benign masses of the ovary. Laparoscopy has the advantage of diagnosis and therapy, safe surgical removal, and ovarian preservation. Histopathological diagnosis still remains the gold standard. Close cooperation between gynecologists, radiologists, and pathologists is essential for successful therapy.

OEP should be ruled out in women of reproductive age who have adnexal masses and atypical complaints. Prompt laparoscopic management with accurate histologic assessment is essential for correct diagnosis, fertility-protection, and to avoid complications. Multidisciplinary cooperation improves the diagnosis and the outcome in these uncommon patients.