Gestational Trophoblastic Disease in Ectopic Pregnancy: A Case Report with Review of Literature

Gestational trophoblastic disease associated with ectopic pregnancy is a rare event and persistent trophoblastic disease is a well recognized complication of conservative surgical treatment for ectopic pregnancy but rarely secondary trophoblastic implantation may occur after salpingectomy. This is a case report of a rare and unusual presentation of persistent trophoblastic implantation following salpingectomy for ruptured ectopic pregnancy. The patient was admitted as an emergency with acute abdomen in severely shocked state. She underwent urgent laparotomy with right salpingectomy for ruptured tubal pregnancy with massive haemoperitonium. Postoperative period was smooth but one month following the operation she developed generalized nonspecific symptoms with high serum BHCG titer which was (50000 IU). Patient had been transferred for the territory trophoblastic disease centre for further follow up. She was kept on combination regimen of chemotherapy. This case presentation was analyzed with other reported case series of the same problem. The analysis of the cases showed that most patients presented with abdominal pain. Some may have vaginal bleeding. Haemoperitonium was the most frequent surgical finding. It is concluded from this case with other previous reported cases that strict histological criteria should be applied for the diagnosis of gestational trophoblastic disease when a sample of ectopic pregnancy is analysed in addition to careful monitoring and follow up of all cases of ectopic pregnancy with serum Human Chorionic Gonadotrophin after surgical treatment.