Abdominal Ectopic Pregnancy After Cesarean Hysterectomy

Abstract

Background:

Ectopic pregnancy occurring after hysterectomy is very rare.

Case:

A 38-year-old woman, para 3 + 0, presented to the emergency department with suprapubic pain, dysuria, and fever. Nine years earlier, due to placenta percreta, she had undergone a total abdominal cesarean hysterectomy, with conservation of her ovaries, at the time of her third cesarean. At presentation her urine pregnancy test was positive and her serum β-human chorionic gonadotropin (β-hCG) was 2409 mIU/mL. An emergency laparoscopy was performed because of this patient's pain and clinical deterioration. A hemorrhagic lesion attached to the sigmoid colon was removed.

Results:

The patient had an uneventful recovery. Histology testing confirmed that the lesion was an extrauterine gestation. Her β-hCG level returned to normal. On further follow-up, the patient and her partner opted for him to have a vasectomy to prevent the potential for another ectopic pregnancy.

Conclusions:

Although this phenomenon is a rare event, any woman presenting with abdominal or pelvic pain, who has had hysterectomy and conservation of ovaries should have pregnancy ruled out.