Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Tubal Stump Ectopic Pregnancy Following Salpingectomy: A Rare Diagnostic Challenge Madison Sacks OMS-III, Steven Lewis MD. VCOM Carolinas, Spartanburg, SC 1. Spartanburg Regional Health Care System, Spartanburg SC

Introduction

Imaging

Discussion

Ͳ Tubal stump ectopic pregnancy occurs when a blastocyst implants in a remnant of the fallopian tube after salpingectomy Ͳ They account for 0.4% of 1,466 ectopic pregnancies in a prior study and are a critical complication with significant morbidity and mortality risks Ͳ History of pelvic inflammatory disease (PID), previous ectopic pregnancies, abdominal surgery, smoking, endometriosis, and intrauterine device (IUD) use during pregnancy are identified risk factors of ectopic pregnancy Ͳ Ultrasound and beta-HCG level measurements are standard methods for diagnosis of ectopic pregnancy Ͳ 29-year-old female (G4P2012) referred to the ED, by her OBGYN, for suspected ruptured ectopic pregnancy Ͳ Significant history: Two prior ectopic pregnancies with prior left salpingectomy Ͳ Presented to the ED with progressive bilateral lower abdominal pain, vaginal bleeding, nausea over two days and declining beta-HCG levels Ͳ POC ultrasound revealed hemoperitoneum and small anechoic free fluid in the cul-de-sac as well as a large right adnexal mass Ͳ Hemoglobin 7.4 g/dL (decreased from 12 g/dL two days prior), hypokalemia (3.1 mmol/L), and vital signs showing hemodynamic instability Ͳ Emergency laparoscopy revealed hemoperitoneum, ruptured ectopic pregnancy in the proximal stump of the left fallopian tube, healthy right fallopian tube and intact uterine cornu Ͳ The patient was stabilized with two units of packed red blood cells transfused and her post-operative course was uneventful with successful recovery Case Presentation

Ͳ Patient expressed relief at preserving fertility potential with an intact right fallopian tube Ͳ The most common site for an ectopic pregnancy is the ampulla of the fallopian tube and is a leading cause of maternal morbidity and mortality Ͳ Surgical intervention remains critical in high-risk cases, such as hemoperitoneum as seen in this case Ͳ Initial misinterpretation of ultrasound findings (right adnexal mass) underscores limitations of ultrasound in diagnosing rare ectopic pregnancies Ͳ Advanced imaging (e.g., MRI) could improve localization accuracy Ͳ Human error and assumptions based on medical history may lead to misdiagnosis or delays Ͳ Optimal amount of residual tube to leave during salpingectomy remains unclear Ͳ General practice is to leave as little residual tube as possible Ͳ This case emphasizes the importance of early recognition, careful monitoring, and timely intervention in patients with a history of ectopic pregnancies, as well in patients following bilateral salpingectomy for sterilization

Figure 1 . Intraoperative image showing hemoperitoneum

Figure 2. Intraoperative image showing left tubal stump ectopic pregnancy

References

1. Homagain S, Kharal N, Khanal H, Shahi T, Pandey J, Katuwal N. Ruptured ectopic pregnancy on a tubal stump: A case report. Clin Case Rep. 2022;10:e06305. doi: 10.1002/ccr3.6305 2. Mullany K, Minneci M, Monjazeb R, Coiado O. Overview of ectopic pregnancy diagnosis, management, and innovation. Women’s Health. 2023;19(19):174550572311603. doi:10.1177/17455057231160349. 3. UpToDate. Ectopic pregnancy: Clinical manifestations and diagnosis. Available from: https://www.uptodate.com/contents/ectopic pregnancy-clinical-manifestations-and-diagnosis 4. Tubal ectopic pregnancy. ACOG Practice Bulletin No. 193. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:091-103. 5. Takeda A, Manabe S, Mitsui T, Nakamura H. Spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after ipsilateral adnexectomy: report of two cases. J Obstet Gynaecol Res. 2006;32(2):190-194. doi: 10.1111/j.1447-0756.2006.00385.x. 6. Jones T, et al. Ectopic pregnancy: Review of management and current guidelines. J Obstet Gynaecol. 2020;60(5):124-130. 7. Williams H, et al. Laparoscopic management of ruptured ectopic pregnancy: A retrospective study. J Minim Invasive Gynecol. 2021;28(4):748-755. 8. Patel S, et al. The role of advanced imaging in the diagnosis of ectopic pregnancy. Radiol Today. 2018;40(2):45-50. 9. Samiei- Sarir B, Diehm C. Recurrent ectopic pregnancy in the tubal remnant after salpingectomy. Case Reports Obstet Gynaecol. 2013;2013 10. Gaughran J, Mitchell S, Holland T. Salpingectomy for ectopic pregnancy: Does length really matter? Int J Reprod Contracept Obstet Gynecol 2021;10:333-5.

Figure 3. Intraoperative images show post-resection of the ectopic pregnancy

2025 Research Recognition Day

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