April 26th, 2018

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Persistent Extratubal Trophoblastic Implants after Salpingostomy and Salpingectomy: A Report of Two Cases
Authors:  Dah-Ching Ding, M.D., Ph.D., and Chi-Yuan Liao, M.D.
BACKGROUND: Persistent trophoblastic implants are a well-known complication of surgical treatment for ectopic pregnancies and occur in 58% of salpingostomy cases. However, this complication is less common with radical salpingectomy. We describe 2 cases of secondary peritoneal (omental) implants after laparoscopic salpingectomy.
CASES: Case 1 was a 23-year-old woman who underwent salpingectomy to treat an ectopic pregnancy and subsequently experienced intraabdominal hemorrhage caused by the rupture of a corpus luteum cyst. The cyst was stimulated and was able to survive as a result of human chorionic gonadotropin (hCG) secretion by persistent trophoblastic tissue along the pelvic wall, as well as the serosa of the sigmoid colon, uterus and omentum. Case 2 was a 22-year-old woman who required 2 omentectomies for extratubal trophoblastic implants after a salpingectomy due to an ectopic pregnancy.

CONCLUSION: These cases highlight the critical importance of postsurgical follow-up after both salpingostomy and salpingectomy, including serial hCG levels and definite therapy with methotrexate, to facilitate early detection of persistent trophoblastic tissue.
Keywords:  corpus luteum, ectopic pregnancy, hemoperitoneum, trophoblastic implants
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