Discussion and conclusion
CP is considered a rare entity that represents 2-4% of all tubal
pregnancies [5]. It could be a life-threatening condition as it
tends to rupture in approximately 48.6% of cases, leading to potential
consequences on the fetus and the pregnant [6]. Risk factors of CP
include: previous ectopic pregnancies, assisted reproductive techniques,
tubal anomaly, proximal intra-tubal adhesions, and rarely ipsilateral
salpingectomy [3, 5]. The symptoms usually occur 9th to 12th weeks
after the LMP due to myometrial stretchability. These include
discomfort, abdominal pain, and abnormal vaginal bleeding [7].
Despite its complexity, early diagnosis of CP poses the cornerstone of
lowering maternal mortality. Clinical features increased β-HCG, and
transvaginal ultrasonography is considered typical diagnostic modalities
[4]. However, ultrasonography could distinguish the gestational sac
in uterine cornua with increased vascularity (Fig.1), [8]. The
literature reports a wide variety of treatment approaches. Previous
interventions commonly included hysterectomy or cornual resection via
laparotomy. However, more conservative laparoscopic approaches have been
implemented recently, including cornual resection, cornustomy, and
salpingectomy [5, 9]. Of interest, the potential persistent ectopic
pregnancy has augmented after the conservative surgical procedures.
However, rupture of CP could stimulate serious intra-abdominal bleeding
resulting in hypovolemic shock; therefore, laparotomy could be preferred
in hemodynamically unstable patients [4]. Besides surgical
treatment, CP can also be managed conservatively by (systemic or local)
methotrexate injections. However, the latter appeared to be more
efficient [6]. The convenient decline in β-HCG blood level indicates
successful management of a CP [10]. Habana et al. discussed the
outcomes of females undergoing surgery versus medical treatment, and the
results revealed the advantages of surgery in terms of miscarriage (13%
versus 50%, p < 0.05) and live birth rate (60.9% versus
50%) [7, 9]. Spontaneous CP after ipsilateral salpingectomy is a
very rare entity in which diagnosis is usually delayed. In conclusion,
salpingectomy could not eliminate the potential of ipsilateral ectopic
pregnancy. Therefore, an early well-organized follow-up of each pregnant
with a history of salpingectomy is recommended to avoid potentially
fatal consequences.