Persistence of a Persistent Ectopic Pregnancy: Laparoscopic Recognition and Treatment

We present a case of a 32-year-old woman who underwent treatment with both linear salpingostomy and methotrexate for an ectopic pregnancy, finally resulting in undetectable β-hCG titers. Despite her clinical response to these combined interventions, she continued to harbor persistent trophoblastic tissue 9 months later. The histologic verification of chronic trophoblastic tissue persisting with negative β-hCG titers has not been reported. We suspect that retained trophoblastic tissue may explain some reports of persistent masses noted by ultrasound and may also explain some cases of tubal occlusion following conservative treatment of ectopic pregnancies. Given the increasing prevalence of conservatively managed tubal pregnancies, the gynecologic surgeon should be aware of this clinical entity, enabling the surgeon to look for, recognize, and treat the persistent tissue appropriately. (J GYNECOL SURG 11:181, 1995).