---

AN UNUSUAL CASE OF POST TUBALLIGATION ECTOPIC PREGNANCY

JIGNESH J KANSARIA*, AMIT PILANKAR**,ALKA GUPTA***, SV PARULEKAR****
*Lecturer; **Third Year Resident; ***Associate Professor; ****Professor, Department of Obstetrics and Gynaecology, Seth GS Medical College, KEM Hospital, Parel, Mumbai.

---

An unusual case of post tubal ligation ectopic pregnancy proving beyond doubt the external migration of sperm theory of development of ectopic pregnancy is reported.

INTRODUCTION

A first case report of pregnancy in lateral segment of fallopian tube after tubal ligation in the absence of spontaneous tubal recanalization or tubo-peritoneal fistula formation.

CASE REPORT

Mrs. SP 38 year old housewife presented with the chief complaint of low grade pain in left lower abdomen since 15 days and of increased intensity since one day.

She had a history of one and a half months of amenorrhoea with regular past menstrual cycles. She had three full term normal deliveries, the youngest child being 14 year old, when she had undergone puerperal tubal ligation by Pomeroy’s method. She had past history of Weil’s disease one year back, fully recovered.

On examination her pulse was 110/min, regular, low volume, BP of 96/70 mmHg and marked pallor.

Abdomino-pelvic examination revealed tenderness and guarding in left iliac fossa. Shifting dullness present. The uterus was retroverted bulky, firm in consistency and tender left transverse cervical movements. There was tenderness in left fornix and feeling of fullness in all fornices.

Pelvic ultrasound showed bulky empty uterus with free fluid in culde sac and peritoneal cavity.

On colpopuncture, there was free flow of fresh blood which did not clot on standing.

Exploatory laparotomy was performed.

Intra operative findings

A haemoperitoneum of 500 ml. Left fallopian tube showed normal appearing post tubal ligation medial segment and the lateral segment showed unruptured gestational sac in it. There was no evidence of continuity between the two segments. Bilateral total salpingectomy was performed, as the right tube showed partial continuity at its antimesosaplingeal border. Corpus luteum was seen in the left ovary.

DISCUSSION

The ectopic pregnancy after failure of tubal ligation is in lateral segment of fallopian tube if there is recanalization at the site of tubal ligation, the recanalised portion being too narrow to transmit the fertilized ovum from lateral to medial segment and then the uterine cavity. [1]

However, in this case, there is no such recanalization. Ectopic pregnancy resulting from tubo - peritoneal fistula formation is outside the fallopian tube but not in the lateral tubal segment. [1] Thus in this case ectopic pregnancy would have resulted from external migration of sperm from the recanalized right fallopian tube and either entry of this sperm and ovum from the left fimbrial end of fallopian tube or intraperitoneal fertilization of ovum and subsequent entry into lateral segment of fallopian tube.

Though it is difficult to decide which one of these mechanisms was responsible for pregnancy, but it proves beyond doubt the external migration of sperm "theory of development of ectopic pregnancy" as has been proposed before. [2]

A detailed search of the Internet including medline search did not reveal any such occurrence in the past.

REFERENCES

1.Te Linde’s Operative Gynaecology. JB Lippincott Company. 7th edition, Pennysylvania. Ectopic pregnancy 1992; 411-36.

2.Williams Obstetrics. Appleton and Lange, 20th edition, Connecticut. Ectopic pregnancy 1997; 607-34.

---

To section TOC