Laparoscopical management of cornual pregnancies: a report of three cases Andrea Tinelli a, *, Antonio Malvasi b , Marcello Pellegrino c , Giovanni Pontrelli b , Bruno Martulli b , Daniel Alberto Tsin d a Department of Obstetric & Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, P.zza Muratore, 73100 Lecce, Italy b Department of Obstetric & Gynecology, Santa Maria Hospital, Bari, Italy c Department of Pathology, Vito Fazzi Hospital, Lecce, Italy d Department of Gynecology, Division of Minimal Invasive Endoscopy, The Mount Sinai Hospital of Queens, NY, USA 1. Introduction An extrauterine or ectopic pregnancy is defined as a pregnancy in which implantation occurs outside the uterine cavity: of all reported pregnancies, 0.4–2% are extrauterine [1]. A pregnancy implanted in the proximal portion of the fallopian tube, that is within the muscular wall of the uterus, is called an interstitial or cornual pregnancy. Anatomically, the interstitial part of the fallopian tube is 0.7 mm wide and approximately 1–2 cm long with a slightly tortuous course. The interstitial or cornual pregnancy is defined by its implantation site and is found in the interstitial region between the proximal portion of the fallopian tube and the musculature of the uterus. The interstitial ectopic pregnancy is located in the intramural portion of the tube covered by myometrium [2]. A cornual pregnancy can be further sub-classified as either ‘‘angular’’ or ‘‘interstitial’’: the former is one that implants medial to the insertion of the round ligament as it crosses the utero-tubal junction, while the latter is one that implants lateral to the round ligament at this junction [3]. Generally, authors use the terms ‘‘cornual’’ and ‘‘interstitial’’ interchangeably with only rare mention of ‘‘angular’’ pregnancies. Due to its rarity, the available literature on cornual pregnancy is from case reports and small series. The general incidence of ectopic gestation is approximately 20 per 1000 pregnancies and cornual pregnancies account for 3% of ectopic gestations [3,4]. The mortality rate for interstitial pregnancies remains at 2.0–2.5%. A cornual gestation is an urgent and dangerous medical issue [4]. The authors describe a series of laparoscopic treatment of cornual pregnancies, followed by discussion regarding the diagnostic and treatment modalities of cornual pregnancies based on a review of the existing literature. 2. Materials and methods The authors report their experience of laparoscopic therapeutic procedures on three singleton cornual pregnancies in healthy Caucasian women. 2.1. Case 1 A 34-year-old woman with an uneventful past gynaecological history, and with multiple pharmacological allergies, was admitted for suspected ectopic pregnancy, with amenorrhoea for 10 weeks European Journal of Obstetrics & Gynecology and Reproductive Biology 151 (2010) 199–202 ARTICLE INFO Article history: Received 26 November 2009 Received in revised form 18 March 2010 Accepted 31 March 2010 Keywords: Ectopic pregnancy Cornual pregnancy Angular pregnancy Interstitial pregnancy Extrauterine pregnancy Laparoscopy Gynaecological endoscopy Minimally invasive therapy Methotrexate ABSTRACT Objective: Cornual pregnancy refers to the implantation and development of a gestation in one of the upper and lateral portions of the uterus; authors report their experience in laparoscopic therapeutic procedures on three singleton cornual pregnancies. Study design: Three healthy women were admitted in General Hospitals with suspect of cornual pregnancies by clinical examination, increasing of b-hCG value and transvaginal ultrasonography. One of them had a haemoperitoneum. Surgeons performed all operative laparoscopies, by incision and enucleating of ectopic cornual mass, coagulating of its surrounding vessels and suturing of the uterine incision site. Results: Patients were successfully treated only by laparoscopy, post-operative recovery period was normal in all women, with no further therapeutically intervention in the follow-up course. The aftermath was uneventful at the follow-up of 2 years. Conclusion: In cornual pregnancies, the minimally invasive surgical treatment by salpingotomy or resection of the cornual region of the uterus and the suturing of the incision site, should be the option in women interested in future fertility. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +39 0339 2074078; fax: +39 0832661511. E-mail address: andreatinelli@gmail.com (A. Tinelli). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb 0301-2115/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2010.03.032