International Journal of Clinical Case Reports 2017, Vol.7, No.13, 53-57
53
Research Report Open Access
About a Case of Failure of Medical Treatment of an Interstitial Pregnancy
Ragmoun Houssem
1
, Daadoucha Abdrahmen
2
, Benhlima Najeh
3
, Ajili Abir
1
1 Department of Obstetric Gynecology Ibn El Jazzar Hospital, University hospital assistant in gynecology obstetrics, Ibn El Jazzar street, Kairouan, 3100,
Tunisia
2 Department of Radiology Ibn El Jazzar Hospital, University hospital assistant in radiology, Ibn El Jazzar street, Kairouan, 3100, Tunisia
3 Department of Cardiology Ibn El Jazzar Hospital, University hospital assistant in cardiology, Ibn El Jazzar street, Kairouan, 3100, Tunisia
Corresponding author email
International Journal of Clinical Case Reports 2017, Vol.7, No.13 doi
Received: 16 Aug., 2017
Accepted: 18 Oct., 2017
Published: 20 Oct., 2017
Copyright © 2017
Houssem et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Houssem R., Abdrahmen D., Najeh B., and Abir A., 2017, About a case of failure of medical treatment of an interstitial pregnancy, International Journal of
Clinical Case Reports, 7(13): 53-57 (doi
Abstract
Interstitial pregnancy is a rare entity that accounts for nearly 2% of ectopic pregnancies. His diagnosis is almost always
based on laparoscopy. The risk of rupture with significant hemorrhage remains high. The treatment is classically surgical by corneal
resection, medical treatment is increasingly used. Through an observation of an interstitial pregnancy diagnosed in our department
and treated initially medically and then by radical surgery and by means of a review of the literature, we will try to explain the
different diagnostic and therapeutic methods used in interstitial pregnancies, we will also learn the importance of patient selection in
order to avoid risky changes, especially in the absence of consensus.
Keywords
Ectopic pregnancy; Corneal pregnancy; Interstitial pregnancy; Corneal resection; Methotrexate
Background
A diagnosis of ectopic pregnancy is made about 1.5 times per 100. In less than 10% of cases, it is a non-tubular
ectopic pregnancy, particularly interstitial or corneal localization, the latter type represent a major challenges since
the delay in diagnosis and therefore in the management can be extremely dangerous. The treatment, previously
always surgical and radical, becomes mostly minimally invasive, based on treatment with methotrexate according
to several schemes.
1 Observation
Mrs. F is 37 years old with an appendectomy in her antecedents. It is a third gesture, second pare, having two live
children normally delivered by low way. She has been undergoing micro-progestogen contraception for 6 months.
She consulted us for minimal blackish metrorrhagia with a ten-week amenorrhea. The clinical examination found
a slight lateral hypogastric sensitivity on the right. Ultrasound (Figure 1) objective an ectopic pregnancy in the
cornual right seat, fetus with positive cardiac activity of 11 weeks of amenorrhea, low abundance effusion in
Douglas.The initial level of ß-hCG was 39,000 mIU / ml. The laparoscopy (Figure 2) showed the presence of a
right cornual pregnancy of 8 cm. Given the desire for further fertility evoked by the patient, we was tempted to
make a conservative treatment, so we applicate an injection of 40 mg of methotrexate in situ by laparoscopic route
in the corneal pregnancy ,followed by an unique injection of 60 mg of methotrexate intramuscularly at the same
day.
On the fourth postoperative day, there was an increase in pelvic pain and a rise in β-hCG levels associated with a
drop in the hemoglobin level (7 grams for an initial of 10.5 grams), a decrease in arterial pressure to 8\6 As well as
hemoperitoneum accumulation at ultrasound ,so a laparotomy was performed on emergency and demonstrated a
righpre break corneal pregnancy with hemorrhage suffusion (Figure 3), in front of low hemoglobin numbers and a
rare blood group (O negative), as well as an unstable hemodynamic state, an hysterectomy was performed, corneal
resection was considered dangerous, after the transfusion of two Red blood cells.
