ABSTRACT
The numbers of ectopic pregnancies have increased because of the popularization of assisted reproductive techniques. However, the retroperitoneal space is an exceptional location for ectopic pregnancy because the entrance to the retroperitoneal space is unknown. A woman 31 years of age who had received bilateral salpingectomy because of a right tubal ectopic pregnancy and a left hydrosalpinx 4 years earlier was treated by in vitro fertilization and embryo transfer (IVF-ET). Ultrasonography and magnetic resonance imaging (MRI) revealed a gestational sac attached to the inferior vena cava in the midabdomen of the retroperitoneal space. Single-dose methotrexate administration was administered twice. However, because of sudden upper abdominal pain with a drastic decline of hemoglobin, an emergent laparotomy was performed. The hematoma and a gestational sac were removed from the aorta and inferior vena cava. Ectopic pregnancy following IVF-ET in a patient with bilateral salpingectomy is likely to be the cause of implantation at this unusual site. An unusual ectopic pregnancy has a high risk of life-threatening massive bleeding. Intensive transabdominal ultrasound scanning and whole abdominal MRI should be performed for the early diagnosis of unruptured ectopic pregnancy.
KEYWORDS
Bilateral salpingectomy - IVF-ET - retroperitoneal ectopic pregnancy - ultrasonography - MRI
REFERENCES
-
1
Assisted reproductive technology in the United States. 1997 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.
Fertil Steril.
2000;
74
641-653
-
2
Agarwal S K, Wisot A L, Garzo G, Meldrum D R.
Cornual pregnancies in patients with prior salpingectomy undergoing in-vitro fertilization and embryo transfer.
Fertil Steril.
1996;
65
659-660
-
3
Fisch B, Peled Y, Kaplan B, Zehavi S, Neri A.
Abdominal pregnancy following in-vitro fertilization in a patient with previous bilateral salpingectomy.
Obstet Gynecol.
1996;
88
642-643
-
4
Chin H Y, Chen F P, Wang C J, Shui L T, Liu Y H, Soong Y K.
Heterotopic pregnancy after in vitro fertilization-embryo transfer.
Int J Gynaecol Obstet.
2004;
86
411-416
-
5
Dmowski W P, Rana N, Ding J, Wu W T.
Retroperitoneal subpancreatic ectopic pregnancy following in vitro fertilization in a patient with previous bilateral salpingectomy: How did it get there?.
J Assist Reprod Genet.
2002;
19
90-93
-
6
Reid F, Steel M.
An exceptionally rare ectopic pregnancy.
BJOG.
2003;
110
222-223
-
7
Hall J S, Harris M, Levy R C, Walrond E R.
Retroperitoneal ectopic pregnancy.
J Obstet Gynaecol Br Commonw.
1973;
80
92-94
-
8
Sotus P C.
Retroperitoneal ectopic pregnancy: a case report.
JAMA.
1977;
238
1363-1364
-
9
Savitskii A G.
Retroperitoneal pregnancy.
Akush Ginekol (Mosk).
1978;
2
63-64
-
10
Ferland R J, Chadwick D A, O'Brien J A, Granai III C O.
An ectopic pregnancy in the upper retroperitoneum following in-vitro fertilization and embryo transfer.
Obstet Gynecol.
1991;
78
544-546
-
11
Lazarov L.
A rare case of a retroperitoneally situated extrauterine pregnancy.
Akush Ginekol (Sofiia).
1993;
32
40-41
-
12
Terrier J P, Garcia S, Hardwigsen J, D'Ercole C, Andrac-Meyer L, Charpin C.
Retroperitoneal ectopic pregnancy: report of a case.
Ann Pathol.
1998;
18
201-202
-
13
Lee J W, Sohn K M, Jung H S.
Retroperitoneal ectopic pregnancy.
AJR Am J Roentgenol.
2005;
184
1600-1601
Seiji TsutsumiM.D. Ph.D.
Yamagata University School of Medicine, Department of Obstetrics and Gynecology
2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
