両側卵管摘出術の既往があったが卵管間質部妊娠となり、MTX療法中に破裂し腹腔鏡下卵管角部切開術を施行した一例

抄録

Introduction: Interstitial pregnancy is a rare subtype of ectopic pregnancy.

Case: Our patient was a 35-year-old woman with a history of bilateral salpingectomy for hydrosalpinx prior to ART. ART was carried out in the clinic, and pregnancy was confirmed. At 5 weeks and 6 days of gestation, the patient presented to the clinic with genital bleeding and lower abdominal pain. The gestational sac and yolk sac were found in the interstitial region of the right fallopian tube, and the patient was referred to our hospital for management. There were no abnormal vital signs, and the blood human chorionic gonadotropin (hCG) level was 5,598 mIU/mL. Magnetic resonance imaging revealed a 16 mm cystic mass in the right interstitial region. Since there were no ruptures and the patient's condition were stable, methotrexate was administered systemically. On 11 days at for MTX administration, the patient's blood hCG levels decreased, but abdominal pain worsened. Sonography and computed tomography showed intra-abdominal bleeding due to rupture. The patient was diagnosed with ruptured interstitial pregnancy, and emergency laparoscopic surgery was performed. We observed a large amount of blood in the pelvis, persistent bleeding from the right uterine horn to the interstitial region of the fallopian tube, and surrounding hematoma. The villi of the stromal oviducts were removed, and the affected area was sutured.

Conclusion: Ectopic pregnancy of the remaining fallopian tubes should be considered, even after salpingo-oophorectomy has been performed.