Persistent tubal pregnancy presenting with postcoital hemorrhage following laparoscopic linear salpingotomy: A case report

Abstract

BACKGROUND: The use of conservative surgical techniques to treat ectopic pregnancies has been reported to increase the rate of incomplete trophoblastic tissue removal and subsequent regrowth.
CASE: Postcoital acute abdominal pain occurred in a woman treated with a laparoscopic linear salpingotomy without suturing for an ampullary ectopic pregnancy 20 days previously. The patient developed clinical symptoms despite satisfactory declining hCG levels. An emergency laparotomy was performed and a 600 ml hemoperitoneum was present The bleeding site of the prior salpingotomy was identified and closed. A few trophoblastic cells were noted in the intratubal clot during pathologic evaluation.
CONCLUSION: This case demonstrates that postoperative rupture and bleeding from the fallopian tube with an ectopic gestation can occur in spite of declining and low hCG values. It is conceivable that the hemorrhage at the site of the prior salpingotomy was caused by not only minimal residual trophoblastic tissue, but also mechanical stimulation during sexual intercourse. It is necessary to evaluate the additional benefit of suturing during linear salpingotomy for ectopic gestations.