Table 1 Summary of all reported cases of retroperitoneal ectopic pregnancy in the English literature (n = 33)
First author,year | Age,y | Previous normal pregnancy | Previous EP/type | Previous tubal surgery | Pregnancy way/Embryo number | Amenorrhea duration (d) | Primary symptoms | Emergency/shock | hCG before treatment (IU/L) | Auxilliary examinations |
|---|---|---|---|---|---|---|---|---|---|---|
Hall, 1973 [4] | 21 | 2 | 1/tubal pregnancy | Right salpingectomy | SP | 35 | Left-sided abdominal pain and fainting | Yes/Yes | NA | No |
Sotus PC, 1977 [5] | 30 | 3 | 0 | No | SP | 73 | Vaginal bleeding, persistent left lower-quadrant pain | No | NA | TAS |
Ferland, 1991 [9] | 32 | NA | 1/tubal pregnancy | Right salpingectomy | IVF/3 | 54 | Right abdominal pain | Yes/No | 19,540 | TAS |
Dmowski, 2002 [10] | 34 | 0 | 0 | Bilateral salpingectomy | IVF/3 | 58 | Right epigastric and right upper back pain, weakness | Yes/Yes | 38,635 | TAS/TVS |
Reid, 2003 [11] | 28 | 2 | 3/tubal pregnancies | Bilateral salpingectomy | IVF/3 | 70 | Severe left iliac fossa pain | No | 5000 | No |
Lee, 2005 [12] | 21 | 0 | 0 | No | SP | 42 | Left flank pain | Yes/No | NA | TAS |
Meire,2007 [13] | 30 | 2 | 0 | No | SP | 161 | Asymptomatic | No | NA | TAS/CT |
Iwama, 2007 [14] | 31 | 0 | 1/tubal pregnancy | Bilateral salpingectomy | IVF/3 | 49 | Slight upper abdominal pain | No | 31,778 | TAS/MRI |
Chang, 2008 [15] | 33 | 2 | 0 | No | SP | 44 | Progressive lower abdominal pain and 3 episodes of syncope | Yes/Yes | NA | TVS |
Lin, 2008 [16] | 19 | 0 | 0 | No | SP | 49 | Right lower quadrant abdominal pain and vaginal spotting | No | 267.31 | TAS/TVS/CT |
Bae, 2009 [17] | 28 | 1 | 0 | No | SP | 54 | Vaginal spotting | No | 20,328.2 | TVS/CT |
Persson, 2010 [18] | 33 | 1 | 1/tubal pregnancy | Right salpingectomy | IVF/2 | 44 | Vaginal bleeding | No | 18,032 | TVS |
Okorie CO, 2010 [19] | 28 | 3 | 0 | No | SP | 47 | Moderate to intermittent significant lower abdominal pain | Yes/No | NA | TAS |
Mart ınez-Varea, 2011 [20] | 37 | 1 | 0 | No | IUI | 43 | Lower abdominal pain | Yes/No | 7787 | TVS |
Jiang, 2014 [21] | 33 | 2 | 1/tubal pregnancy | Right salpingectomy | SP | 54 | mild lower abdominal pain | No | 18,920 | TVS/TAS/MRI/CT |
Liang,2014 [22] | 26 | 0 | 1/tubal pregnancy | Left salpingectomy | IVF/3 | 90 | left intermittent flank pain | No | 1076 | TVS/TAS/CT |
Protopapas, 2014 [23] | 31 | 1 | 1/tubal pregnancy | Right salpingectomy | SP | 42 | Asymptomatic | No | 9832 | TVS |
Ouassour,2017 [24] | 35 | 2 | 1/tubal pregnancy | Left salpingectomy | SP | 49 | Asymptomatic | No | 6000 | TVS/TAS/MRI |
Yang, 2017 [25] | 32 | 5 | 0 | No | SP | 38 | Left lower abdominal pain accompanied with mild nausea, tender breasts, and rectal pressure | No | 1880 | TVS |
Pak,2018 [26] | 30 | 3 | 0 | No | SP | 62 | Left flank and abdominal pain, vaginal bleeding | Yes/Yes | 40,532 | No |
Yang,2018 [27] | 34 | 1 | 0 | No | SP | 52 | Bellyache, dizziness, flustered, fatigue, thirsty, and urinary incontinence | Yes/Yes | 6803 | TVS/CT |
Veleminsky, 2018 [28] | 38 | NA | 0 | No | SP | 49 | Asymptomatic | No | 33,742 | TVS/TAS |
Zhang, 2018 [29] | 29 | NA | 0 | No | SP | 60 | Left lower flank pain | No | 36,312 | TVS/TAS |
Huang, 2019 [30] | 37 | 0 | 0 | Bilateral salpingectomy | IVF/2 | 68 | Asymptomatic | No | 88,165 | TAS/MRI |
Huang, 2019 [30] | 31 | 0 | 1/tubal pregnancy | Right salpingostomy | SP | 73 | Asymptomatic | No | 97,333 | TAS/CT |
Lu, 2019 [31] | 31 | 1 | 1/tubal pregnancy | Right salpingostomy | SP | 54 | Vaginal spotting and lower abdominal pain | No | 47,440 | TVS/TAS |
Wang, 2020 [32] | 33 | 2 | 3/tubal pregnancies | Bilateral salpingectomy | IVF/2 | 52 | Left back pain, worsening | No | 74,678 | TVS/TAS/CT |
Le,2020 [33] | 31 | NA | NA | Bilateral salpingectomy | IVF/1 | 41 | Acute epigastric pain | Yes/No | 20,625 | TVS/TAS/CT |
Hou, 2021 [34] | 29 | 1 | No | No | SP | 49 | First asymptomatic, then acute intolerable left abdomen pain | Yes/No | 28,746 | TVS/TAS/CT |
Anh,2021 [35] | 34 | 3 | 2/tubal pregnancies | Bilateral salpingectomy | IVF/2 | 51 | Vaginal bleeding | No | 36,386 | TVS/TAS/MRI |
Wen, 2021 [36] | 28 | 2 | No | No | SP | 60 | Left lower quadrant abdominal pain | Yes/No | 99,286 | TAS/MRI |
Lorenzo,2021 [37] | 33 | 0 | 0 | No | SP | 56 | Acute abdominal pain | Yes/No | 1053 | TVS |
This case | 29 | 1 | 0 | No | SP | 50 | Lower quadrant abdominal pain | Yes/No | 65,004 | TVS/TAS/CT |
First author,year | Implantation site of REP | Size of the lesion (cm) | Embryo/cardiac activity | Initial diagnosis | Initial treatment method | Final treatment method | Rupture of REP | Blood transfusion | Definitive diagnosis |
|---|---|---|---|---|---|---|---|---|---|
Hall, 1973 [4] | above the bifurcation of the aorta | NA | No | - | Laparotomy/RRP | No | Yes | Yes | Surgical findings and pathology |
Sotus PC, 1977 [5] | left side of the aorta and the superolateral side of the left iliac artery | 8 × 10 | Yes/No | Adnexal EP | Suction, D&C and laparoscopy, unremarkable | Laparotomy/partial RRP | No | No | Surgical findings and pathology |
Ferland, 1991 [9] | Upper abdominal retroperitoneal space | NA | No | - | Laparotomy/RRP | No | Yes | No | Pathology |
Dmowski, 2002 [10] | Posterior to the duodenum and adherent to the head of pancreas | 2 × 3 | No | Failing intrauterine pregnancy after IVF | Laparotomy/RRP | No | Yes | Yes | Surgical findings and pathology |
Reid, 2003 [11] | The bifurcation of the common iliac artery | 6 × 6 | No | Miscarriage | Evacuation of uterus | Laparoscopy, converted to Laparotomy/partial RRP | No | No | Pathology |
Lee, 2005 [12] | Left paraaortic region below the left kidney | 5 | Yes/Yes | REP | Laparotomy/partial RRP | No | No | No | Surgical findings and pathology |
Meire,2007 [13] | Retroperitoneal paravesical space on the right pelvic cavity | NA | Yes/No | Intrauterine midterm ancephalus | Vaginal induced abortion | Laparotomy/RRP | No | No | Surgical findings |
Iwama, 2007 [14] | Adjacent to the aorta and pressed on the inferior vena cava | 4.0 × 2.5 | Yes/No | Adnexal EP | Evacuation of the uterus, diagnostic laparoscopy and then two-round i.m.MTX(50 mg/m2/per time) | Laparotomy/RRP | No | No | Surgical findings |
Chang, 2008 [15] | Retroperitoneal space of the left paracolic sulcus | NA | No | Adnexal EP rupture | Laparoscopy/RRP | No | No | No | Surgical findings and pathology |
Lin, 2008 [16] | At the right obturator foramen area | 4.0 × 4.0 | No | Adnexal EP | Diagnostic laparoscopy and D&C | Laparotomy/RRP | No | No | Pathology |
Bae, 2009 [17] | Implanted on inferior vena cava | 3.4 × 2.6 | Yes/Yes | Cornual pregnancy | Laparoscopic wedge resection of the left uterine cornua and D&C | Laparoscopy/RRP | No | No | Surgical findings and pathology |
Persson, 2010 [18] | In the obturator fossa | NA | Yes/Yes | Adnexal EP | First laparoscopic left salpingectomy | Second diagnostic laparoscopy/Robot- assisted laparoscopy/RRP | No | No | Surgical findings and pathology |
Okorie CO, 2010 [19] | Overlying the inferior vena cava and the aorta near the second and third parts of the duodenum | 3.8 × 4.1 cm then increased to 8.2 × 6.6 cm | No | Adnexal EP rupture | Exploratory laparotomy, then intramuscular MTX(100 mg), HCG declinced but abdominal pain aggravated | Emergent laparotomy/RRP | No | No | Pathology |
Mart ınez-Varea, 2011 [20] | Next to the left uterosacral ligament | 3.0 × 2.0 | Yes/No | adnexal EP | Laparoscopy/RRP | Postoperative i.m. MTX50mg/m2 | No | No | Surgical findings and pathology |
Jiang, 2014 [21] | Inferior to the duodenum and attached to the surface of the inferior vena cava, as well as the abdominal aorta | 6.0 × 6.0 | Yes/No | Choriocarcinoma | D&C/intramuscular MTX (daily 20 mg for 5 consecutive days), HCG declined slowly | Laparotomy/RRP | No | No | Pathology |
Liang,2014 [22] | Next to the abdominal aorta, ovary vessels and the left renal vein | 6.5 × 5.4 | Yes/No | adnexal EP | Laparoscopic right salpingectomy, HCG elevated | Laparotomy/RRP | No | Yes | Surgical findings and pathology |
Protopapas, 2014 [23] | Retroperitoneal broad ligament | 3 × 2.5 | Yes/Yes | Cornual pregnancy | Diagnostic laparoscopy | Second laparoscopy combined with hysterscopy guided with transvaginal ultrasound probe | No | No | Surgical findings and pathology |
Ouassour,2017 [24] | Attached to the left side of abdominal aorta | 6.0 | Yes/No | adnexal EP | Exploratory laparotomy | Second laparotmy/RRP | No | No | Surgical findings and pathology |
Yang, 2017 [25] | Lateral to the left sacrocervical ligament | 2.1 × 2.0 | No | adnexal EP | Laparoscopy/RRP | No | No | No | Surgical findings and pathology |
Pak,2018 [26] | Retroperitoneal space on the left pelvic cavity | NA | No | 休克直接开腹 | First emergent laparotomy/ICU | Second laparotomy/evacuated hematoma | Yes | Yes | Pathology |
Yang,2018 [27] | In the right lateral abdominal peritoneum region | 12.0 × 8.0 | No | REP | Laparoscopy/RRP | No | Yes | No | Surgical findings and pathology |
Veleminsky, 2018 [28] | Above the vena cava inferior | 2.7 | Yes/No | Miscarriage/anembryonic pregnancy | Evacuation | Diagnostic laparoscopy/Laparotomy/RRP | No | No | Surgical findings and pathology |
Zhang, 2018 [29] | On the left side of the abdominal aorta and encased the left renal vessels | 4.1 × 2.9 cm,increasing to 11.0 cm | Yes/No | REP | MTX and selective arterial embolization therapy, HCG elevated | Laparotomy/RRP | No | No | Surgical findings |
Huang, 2019 [30] | Under the left renal hilum, in front of the psoas muscle, and to the left of the abdominal aorta | 4.2 × 4.2 | Yes/Yes | REP | 100 mg MTX injecting into the gestational sac under CT guidance | No | No | No | Radiological findings and gestational sac fluid pathology |
Huang, 2019 [30] | Adjacent to the left renal hilum, the abdominal aorta, and the IVC, anterior and to the left of the L3 vertebra | 4.6 × 3.4 | Yes/No | REP | 75 mg MTX injecting into the gestational sac under CT guidance | No | No | No | Radiological findings and gestational sac fluid pathology |
Lu, 2019 [31] | Adjacent abdominal aorta and inferior vena cava | 3.0 × 2.3 | Yes/Yes | REP | Laparoscopy/partial RRP | No | No | No | Surgical findings and pathology |
Wang, 2020 [32] | Implanted in the left psoas major muscle at the position of the left renal hilum | 4.9 × 3.9 | Yes/No | Embryo arrest | First D&C for intrauterine embryo arrest | Laparotomy/RRP with 10 mg MTX injected locally | No | No | Surgical findings and pathology |
Le,2020 [33] | Attached to the left side of the abdominal aorta | NA | No | REP | Laparotomy/RRP | No | No | No | Surgical findings |
Hou, 2021 [34] | Between the abdomi-nal aorta and left common iliac artery | 2.7 × 2.5, then6 × 6 cm | Yes/No | adnexal EP | Diagnostic laparoscopy | Emergent laparotomy/RRP | Yes | Yes | Surgical findings and pathology |
Anh,2021 [35] | In close proximity to the right common iliac artery | 2.5 × 2.0 | Yes/No | Intraabdominal EP | Laparoscopic removal of a small abdominal mass/evacuation of uterus | Second laparotomy/RRP | No | No | Surgical findings and pathology |
Wen, 2021 [36] | Below the left renal vessels and the abdominal aorta | 5.0 × 4.0 | Yes/Yes | Intrauterine pregnancy | D&C for induce abortion, HCG increased | Laparoscopy and 50 mg MTX injected locally/RRP | No | No | Surgical findings and pathology |
Lorenzo,2021 [37] | At the left posterior parametrium | 3 | Yes/Yes | adnexal EP | Diagnostic laparoscopy/MTX (50 mg/m2 body surface area), HCG elevated | Second laparoscopy /RRP | No | No | Surgical findings and pathology |
This case | Attached tightly to the surface of inferior vena cava and the left side of abdominal aorta | 4.5 × 4.0 | Yes/Yes | REP | Intramuscular MTX (daily 20 mg for 2 consecutive days), and US-guided local injection of KCl, HCG increased | Laparotomy | No | No | Surgical findings and pathology |