Ectopic Pregnancy Diagnosed Post Caesarean Surgery in a Three Year Old Boerboel Bitch

A three year old nulliparous Boerboel bitch presented with complaints of fever and inappetence six weeks after an elective caesarean section was diagnosed with an extrauterine foetus. A per-cutaneous abdominal ultrasound revealed a foetal sac showing a well-developed skeletal structure and the absence of foetal movement or heartbeat. During laparotomy, a foetal sac containing a dead foetus was located between the spleen and the stomach. The foetal sac was excised following ligation of its mesenteric attachment to the spleen. The previously operated uterus was observed to have involuted but revealed a small bud observed on the middle portion of the left uterine horn. The histological findings of the foetal sac revealed fibro-adipose tissue with numerous congested vessels. It was concluded that the Boerboel bitch had a secondary abdominal ectopic pregnancy and recommended that owing to the difficulty of diagnosing the condition before or during routine elective caesarean surgery, post-operative abdominal ultrasound would have been instructive.

Successful pregnancy and term delivery after treatment of unicornuate uterus with non-communicating rudimentary horn pregnancy with local methotrexate injection followed by laparoscopic resection: a case report and literature review

Background Pregnancy in a rudimentary horn is an extremely rare type of ectopic pregnancy. A rudimentary uterine horn pregnancy is associated with a risk of spontaneous rupture and bleeding during surgery due to the increased uterine blood flow. Recent advances in imaging modalities have enabled laparoscopic surgery to be performed in cases without rupture in the early stages of pregnancy. However, there are few reports of successful pregnancies and deliveries after treatment of rudimentary horn pregnancies. We report the successful management of a case of non-communicating rudimentary horn pregnancy by local injection of methotrexate followed by complete laparoscopic excision along with a review of the literature. Case presentation The patient was a 29-year-old Japanese woman, gravida 2, nullipara. She was diagnosed with a left unicornuate uterus with a right non-communicating rudimentary horn on hysterosalpingography and magnetic resonance imaging. A gestational sac with a heartbeat was observed in the right rudimentary uterine horn at 6 weeks of gestation. A diagnosis of ectopic pregnancy in a non-communicating rudimentary horn was made. Color Doppler detected multiple blood flow signals around the gestational sac, which were clearly increased compared to the left unicornuate uterus. Her serum human chorionic gonadotropin level was 104,619 mIU/ml. A 100 mg methotrexate injection into the gestational sac was administered, and laparoscopic surgery was performed on day 48 after the methotrexate treatment. The right rudimentary horn and fallopian tube were successfully excised with minimal bleeding. A spontaneous normal pregnancy was established 6 months after the surgery. The pregnancy was uneventful, and a baby girl was born by elective cesarean section at 38w0d. Conclusion Combined local methotrexate injection and laparoscopic surgery are safe treatment options for patients with a unicornuate uterus with a non-communicating rudimentary horn pregnancy.