卵管峡部妊娠後の自然妊娠に伴う同側卵管間質部妊娠の1例

抄録

Objective: Interstitial pregnancies account for 2–4% of all ectopic pregnancies and its incidence is increasing because of the rise in sexually transmitted diseases and assisted reproductive technology. Interstitial pregnancy after ipsilateral salpingectomy is a rare condition with potentially serious consequences.

In this study, we report a case of a patient with interstitial pregnancy who conceived naturally following ipsilateral salpingectomy.

Patient: A 26-year-old woman gravida 3 para 1 with a history of laparoscopic right salpingectomy for ectopic pregnancy had lower abdominal pain and vaginal bleeding. Transvaginal ultrasonography revealed intrapelvic hemorrhage and no gestational sac in the uterine cavity. The human chorionic gonadotropin level in the blood was 3,674 mIU/mL. After admission, she felt severe lower abdominal pain. We suspected abortion of intrauterine pregnancy or ectopic pregnancy. Intrauterine curettage and emergency laparoscopic surgery were performed on the same day. Approximately 650 mL of blood in the abdominopelvic cavity was obtained, and right interstitial pregnancy with bleeding was observed. We removed all gestational tissue and performed laparoscopic right interstitial wedge resection.

Conclusion: The remaining fallopian tube following salpingectomy carries the risk of interstitial pregnancy. In addition, ipsilateral interstitial pregnancy should be considered in a natural conception setting after salpingectomy because of isthmic tubal pregnancy.