Severe intra-abdominal bleeding from neglected omental implantation of ectopic tissue after methotrexate treatment for persistent ectopic pregnancy

Objective: To describe a case of severe intra-abdominal bleeding from omental implants after laparoscopic linear salpingostomy for ectopic pregnancy (EP). Design: Case report. Setting: A medical center. Patient(s): A 27-year-old woman, presenting 15 days after methotrexate (MTX) treatment for persistent EP (35 days after laparoscopic linear salpingostomy for EP). Intervention(s): Partial omentectomy. Main Outcome Measure(s): Serial beta-hCG levels after partial omentectomy. Result(s): Histopathologic examination confirmed omental pregnancy. Her beta-hCG levels decreased rapidly from 1,673 mIU/mL to 1.35 mIU/mL within 14 days after partial omentectomy. Conclusion(s): Persistent EP after laparoscopic linear salpingostomy can occur in the omentum; meticulous clinical follow-up should be performed, especially when IM MTX injection was used as the salvage treatment for persistent EP. (Fertil Steril (R) 2011; 95: 2435.e1-e3. (C) 2011 by American Society for Reproductive Medicine.)