卵管妊娠破裂に対する腹腔鏡下卵管摘出術後に生じたpersistent ectopic pregnancy

抄録

  Persistent ectopic pregnancy, a common complication of a salpingotomy for tubal pregnancies, is diagnosed by a secondary rise in serum human chorionic gonadotropin (hCG). However, it rarely occurs after a salpingectomy; therefore, the need for assessment of the hCG level after a salpingectomy is not widely recognized. The present report demonstrated the need for hCG follow-up assessment even after a salpingectomy.

  A 28-year-old female patient was transferred to our hospital due to suspected ectopic pregnancy. She had slight tenderness in the lower abdomen, but her general condition was stable. Her hCG level was 2,551.0 mIU/ml. In the transvaginal ultrasound examination, gestational sac was not found in the uterus or adnexa. Laparoscopic surgery was performed for the suspected ectopic pregnancy. Ruptured pregnancy in the left tubal ampulla and slight hemorrhagic ascites were found intraoperatively, and a left salpingectomy was performed. The hCG decreased gradually, and she was discharged on postoperative day 5 without complications. Her hCG increased again to 445.9 mIU/ml at the follow-up examination on postoperative day 15. The uterus and adnexa were normal in transvaginal ultrasound. Based on these findings, persistent ectopic pregnancy was diagnosed, and administration of methotrexate 50 mg/m² was begun on postoperative day 18. Thereafter, the hCG decreased and normalized by postoperative day 43.

  In the present case, follow-up assessment of hCG after the salpingectomy led to early diagnosis of persistent ectopic pregnancy, indicating the need for follow-up assessment of hCG after a salpingectomy, especially in patients with spillage of trophoblast.