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.