Unruptured Left Cornual Ectopic Pregnancy Mohammed Khairy Ali, MBBCh, MSc, Ahmed M. Abbas, MBBCh, MSc, Ahmed Y. Abdelbadee, MBBCh, MSc, and Sherif A. Shazly, MBBCh, MSc Abstract Background: A cornual pregnancy is an ectopic pregnancy that develops in the interstitial portion of the Fallopian tube, invading through the uterine wall. Cornual pregnancies often rupture later than other tubal pregnancies because the myometrium is thick and more distendable than the Fallopian tubes are. Cornual pregnancy is usually associated with high vascularity, which may result in severe hemorrhage and death. Morbidity and mortality of cornual pregnancy are directly related to length of time for diagnosis. Case: A 30-year-old woman in her eighth week of pregnancy had abdominal pain and vaginal spotting. Ultrasound (US) examination showed a bulky uterus together with a gestational sac situated in the left cornual region. Left cornual resection was carried out with preservation of the uterus. Results: The patient’s postoperative course and follow-up were uneventful. Conclusions: Cornual pregnancy is a very rare and potentially dangerous condition. Diagnosis of cornual pregnancy can be made via US examination. Cornual resection was done in the present case without immediate or long-term complications ( J GYNECOL SURG 29:314). Introduction E ctopic pregnancy occurs when the fertilized ovum be- comes implanted in tissue other than the endometrium. 1 Although most ectopic pregnancies are located in the Fallopian tubes, especially the ampullary segments, such pregnancies may found at other sites. Classically, cornual or interstitial pregnancies present symptoms and signs later that in Fallopian tube pregnancies, 2 because the gestational sac is surrounded by thicker myometrial walls rather than the weaker thin-walled Fallopian tubes. Interstitial pregnancy occurs in areas that are more highly vascularized; thus, if a rupture occurs, hemor- rhaging will be profound. Pharmaceutical treatment, cornual resection, uterine artery embolization, and hysterectomy are the treatments of choice for cornual pregnancies. 3 Case A 30-year-old woman, gravida 3, para 2 + 0, was admitted to the Assiut Women’s Health Hospital, Assiut, Egypt, with a history of 8 weeks of amenorrhea, intermittent vaginal bleeding, and severe lower abdominal pain of 2 days’ duration. A urine pregnancy test on the day of this patient’s admission was positive. She had was no past history of contraception use or previous operations. On general examination, this patient was conscious, with a pulse of 100 beats per minute, a temperature 37.2°C, and blood pressure 110/70 mm Hg; her cardiovascular and re- spiratory systems were normal. Her abdomen was tender on palpation with positive rebound and guarding. On pelvic examination, it was noted that she had mild spotting, her cervical os was closed, and her cervix was tender on trans- verse motion. Her uterus was bulky; there was tenderness in all the fornices; and the adnexae were difficult to palpate. Hematologic examination showed a white blood cell countof 8 · 109 cells/L and a hemoglobin level of 9.5 g/dL. Transabdominal and transvaginal ultrasonography were performed and showed a bulky uterus, homogenous texture, and a thick endometrium with a smooth outline. No free intraperitoneal fluid collection was detected. There was a gestational sac sized * 4 cm in diameter at the left cornua of the uterus. A small fetal pole sized 1 cm was noted, but there was no fetal heart activity. The patient was counseled concerning the possibility of a cornual ectopic pregnancy, and informed consent for abdominal exploration with the possible need for hysterec- tomy was obtained. An emergency exploratory laparotomy through the Pfannenstiel opening was performed under general anesthesia. This procedure revealed a bulky uterus and a mass that protruded in the left cornual region * 4 cm in diameter (Fig. 1). This finding correlated with the physical examination and ultrasonography. Both Fallopian tubes and both ovaries were noted to be normal. Left cornual resection was done carefully without perforation in the intrauterine cavity (Fig. 2). (Figure 3) shows the left cornual resection with gestational sac. The myometrium was approximated with a figure-of-eight closure using No. 1-0 chromic catgut. Woman’s Health Hospital, Assiut University, Assiut, Egypt. JOURNAL OF GYNECOLOGIC SURGERY Volume 29, Number 6, 2013 ª Mary Ann Liebert, Inc. DOI: 10.1089/gyn.2013.0043 314