PMC2963121_01
Preoperative ultrasonographic image. EM: endometrium, GS: gestational sac. GS was distinct from EM at the left side of the uterus.
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fig1
Transvaginal sonography revealed an ill-defined gestational sac and a fetal heart beat within the fundal myometrium, adjacent to the left cornua (Figure 1).
GS: gestation sac, TUBE: residual left fallopian tube. The GS was separate from residual left tube.
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This cyst was distinct from the residual left fallopian tube (Figure 2).
GS: gestation sac. The uterus was cut with the harmonic scalpel, and the forceps were used to grasp the GS.
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When the scalpel reached the gestational sac (Figure 3), serous fluid was released.
Histologic examination. Microscopic examination demonstrating villi within the myometrium and stroma.
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Diffuse villi and decidual tissue were present within the uterine myometrium (Figure 4).
Perioperative serum beta-hCG levels. "Preop" is one day before surgery, and "POD6" is 6 days post surgery, "POD14" is 14 days post surgery. The beta-hCG dropped rapidly postoperatively.
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The patient's postoperative course was uneventful, and the hCG level decreased appropriately (Figure 5).
Postoperative HSG (hysterosalpingography). No filling defect is evident. Therefore the excised portion of the uterus containing the pregnancy was not one horn of a bicornuate uterus.
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Followup hysterosalpingography (HSG) three months postoperatively showed no change in the appearance of the uterus (Figure 6) as compared with an HSG obtained prior to the pregnancy.
HSG prior to the pregnancy. The left tube was transected at the site of a previous ectopic pregnancy (left tubal pregnancy).
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fig7
Additionally, the absence of a filling defect confirmed that the tissue removed was not a horn of a bicornuate uterus (Figure 7).