Ultrasound-assisted intraoperative localization and laparoscopic management of a previously missed unruptured retroperitoneal ectopic pregnancy

Primary retroperitoneal ectopic pregnancy represents an extremely unusual entity with a rather obscure pathogenesis. Implantation in the retroperitoneal space has been reported to occur both spontaneously and with use of assisted reproduction techniques. The pelvic and the upper retroperitoneum have both been involved, and implantation in the most unusual anatomic sites has been reported. The majority of retroperitoneal gestations are located close to large blood vessels, and laparotomy is performed because of the high risk of massive hemorrhage. Few cases have been treated with laparoscopy so far. We report the case of an early first-trimester retroperitoneal broad ligament live pregnancy occurring after spontaneous conception in a patient who had a history of an ipsilateral tubal ectopic pregnancy, previously treated with laparoscopic right salpingectomy. Current gestation had been missed during initial laparoscopy, and was located and removed during a repeat laparoscopic procedure under intraoperative ultrasonographic guidance.