Surgical treatment of interstitial pregnancy without cornual resection: A case report

Rationale: Interstitial pregnancy (IP) is a rare but extremely life-threatening form of ectopic pregnancy. The traditional surgical treatment for this anomaly is the resection of uterine cornua or fallopian tubes, which often damages their structural integrity, thereby compromising the reproductive potential for women who wish to preserve fertility. Patient concerns: A 33-year-old female was admitted to our hospital with suspected ectopic pregnancy, following a 4-weeks history of positive pregnancy tests after uterine evacuation. The patient was hemodynamically stable on arrival. Ultrasound revealed an empty uterus with an eccentric gestational sac located at the fundus and surrounded by a thin myometrium, indicative of a suspected interstitial pregnancy. Diagnosis and intervention: After failed attempt at medical management with a single dose of intramuscular methotrexate, the patient was arranged for hysteroscopy-assisted laparoscopy. In surgery, the uterine cavity appeared empty, and a 2 x 2 cm bulge with increased vascularity at the right uterine courna was identified upon examination. The gestational sac was aspirated through the vagina from the right ostium of the uterine tube using a suction curette pointing at the right ostium. Sutures were not needed afterward, and the myometrial anatomy was left undisrupted. The diagnosis of IP was confirmed by the postoperative histological report. Outcomes: Perioperative blood loss was approximately 10 ml and the operative time was 40 minutes. The patient had an uneventful postoperative recovery and was discharged after 3 days. Subsequent follow-ups showed a significant reduction in the patient serum beta hCG to 48IU/L within 5 days postoperation, and a negative result after 7 days. Lessons: This novel surgical technique is an alternative minimally-invasive approach for selected early diagnosed and hemodynamically stable IP patients. The technique represents a safe, quick, and simple approach combining the benefits of laparoscopy, such as allowing for immediate conversion of cornuectomy when uterus ruptures, and the benefits of suction curettage, such as shorter operative time and minimal blood loss. We believe patients with interstitial pregnancy who still have fertility wishes would benefit from this surgical technique to a larger extent in the future.