無症状で経過した卵管切除後の同側卵管間質部妊娠破裂に対して腹腔鏡手術を施行した１例

抄録

　Most ectopic pregnancies occur in a ampulla of a fallopian tube, and it is estimated that ipsilateral interstitial pregnancy after salpingectomy accounts for 0.3-4.2% of all ectopic pregnancies. Although interstitial pregnancies are rare, they are prone to heavy bleeding if ruptured, due to abundant blood flow in the myometrium, and prompt treatment is desirable. We report a case of spontaneous pregnancy after salpingectomy, in which an ipsilateral interstitial pregnancy was suspected, but the patient had no symptoms. The pregnancy ruptured before deciding on laparoscopic surgery.

　The patient was 34 years old, 2 pregnancies and 0 deliveries, with a history of right salpingectomy for ectopic pregnancy. Her serum hCG level was 4,960 mIU/mL at 7 weeks and 2 days after her last menstrual period, but no fetal sac was found in the uterus. Ultrasound sonography revealed an 11 mm-sized cyst on the right side of the uterine fundus. There were no symptoms. The hCG level did not decrease after three days. The patient underwent dilation and curettage first, and if the hCG level did not decrease, laparoscopic surgery was planned. The day after surgery, hCG level was elevated, and ultrasound sonography showed ascites effusion. Suspecting a ruptured ectopic pregnancy, laparoscopic surgery was performed. A thinning and bulging of the myometrium in the right fallopian tube interstitium, as well as persistent bleeding were observed. Laparoscopic fallopian tube interstitial resection was performed. Postoperatively, hCG level decreased, and pathological examination revealed trophoblastic tissue in the resected area.