A tale of two laparoscopies: Diagnosing and treating a challenging case of interstitial ectopic pregnancy

Introduction: Interstitial ectopic pregnancy (IEP) is a rather uncommon but potentially life-threatening type of ectopic implantation with a high-risk of delayed diagnosis and severe morbidity of the mother. It is usually complicated by the presence of typical clinical presentation and inconclusive early-term imaging, which makes it difficult to detect timely. Case Report: we describe the case of a non-pregnancy female, aged 26 years, who reported at six weeks of gestational age with intermittent abdominal pain at the lower part and increased 8-hCG levels. The first transvaginal ultrasound was unable to localize the pregnancy and laparoscopy performed initially was inconclusive. The continued symptoms and the increasing level of the 2 hCG stimulated additional investigation by use of the magnetic resonance imaging, MRI, which revealed a lesion typical of interstitial ectopic pregnancy. A second laparoscopy made the diagnosis and allowed surgical resection. Because of the persistent 50 of 2-hCG postoperative, adjunctive methotrexate treatment was given with total resolution. Conclusion: The case raises the issue of the complexity of diagnosis of interstitial ectopic pregnancy, especially in patients whose pelvic anatomy is altered. It highlights the value of keeping a high level of suspicion, the supplementing nature of MRI in cases where investigations within the first stage are inconclusive and the value of a combination of surgical and medical treatment in the final results.