Subsequent left distal tubal pregnancy following laparoscopic tubal sterilization: a case report

Abstract

Subsequent left distal tubal pregnancy following laparoscopic tubal sterilization: a case report Chung-Yuan Lee1,2,3,† , Ching-Min Lin4,† , Yi-Sin Tan5 , Che-Min Chen1 , Hsing-Ju Su1 , Ling-Yun Cheng1 , Chin-Jung Wang6,* 1Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan 2Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, 61363 Chiayi, Taiwan 3 Institute of Medicine, Chung Shan Medical University, 40201 Taichung, Taiwan 4Department of Surgery, Changhua Christian Hospital, 500209 Changhua City, Taiwan 5Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, 88301 Kaohsiung, Taiwan 6Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Chang Gung University College of Medicine, 333 Taoyuan, Taiwan *Correspondence: wang2260@gmail.com (Chin-Jung Wang) †These authors contributed equally. Academic Editor: Michael H. Dahan Submitted: 18 December 2020 Revised: 23 February 2021 Accepted: 8 March 2021 Published: 7 June 2022 Abstract Background: Post-sterilization pregnancies are rare and many postulations were made for its mechanism. Abdominal pain in women with retained uterus mandates a pregnancy test, regardless of previous tubal surgery or sterilization surgery to exclude the possibility of ectopic pregnancy. Prevention via surgical approach not only prevents future occurrence but also confer prophylaxis measure against ovarian cancer. Case: A 39-year-old woman who had undergone open right salpingectomy due to tubal pregnancy presented with abdominal pain, a positive pregnancy test, and elevated beta-human chorionic gonadotropin (β-hCG) level. Furthermore, an ultrasound exam revealed the absence of a gestational sac in the uterine cavity but the presence of a left adnexal mass; hence ectopic pregnancy was suspected. Laparoscopy revealed a 3 × 4 cm bulging ectopic pregnancy at the left distal end of the remnant stump in the ampulla. The histopathological assessment confirmed ectopic pregnancy in the left distal tubal stump. Post-operation, β-hCG levels decreased. The patient fully recovered postoperatively. Discussion: Ectopic pregnancies after tubal sterilization are caused by fistula formation and intraperitoneal sperm transmigration. To avoid this possibility, surgical techniques should be used to obliterate the residual canal, including the precise location and depth of electrocautery to prevent fistula formation. Total salpingectomy is the recommended treatment approach for effective permanent sterilization and a prophylaxis measure against ovarian cancer. Keywords: Ectopic pregnancy; Fallopian tube pregnancy; Sterilization; Laparoscopic tubal sterilization; Contraceptive method