A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma


  • Suman S. Sharma Department of Obstetrics and Gynecology, SSG Hospital, Baroda Medical College, Baroda, Gujarat, India
  • A. V. Gokhale Department of Obstetrics and Gynecology, SSG Hospital, Baroda Medical College, Baroda, Gujarat, India
  • Shonali Agrawal Department of Obstetrics and Gynecology, SSG Hospital, Baroda Medical College, Baroda, Gujarat, India




Broad ligament, Ectopic Pregnancy, Interstitial ectopic, Ultrasonography


The ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Interstitial ectopic pregnancies are gestations that implant within the proximal, intramural portion of the fallopian tubes with high vascularity. Ectopic pregnancy in the interstitial part of the fallopian tubes can be life-threatening considering the thin myometrial tissue surrounding the gestational sac and high vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. Being a hazardous type of ectopic pregnancy, it becomes extremely important to diagnose and manage it. This condition presents a challenge for clinical as well as radiological diagnosis. Generally, a case of interstitial ectopic pregnancy has typical radiological features distinguishing it from other ectopic. The ultrasonographic finding of interstitial line has better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy. Ultrasound is the mainstay of diagnosis, but magnetic resonance imaging can be helpful in unusual or complicated cases. Interstitial ectopic pregnancy rupturing into the leaves of broad ligament and creating a tamponade effect to alter the clinical presentation is a rare event which presents as a diagnostic challenge. Here authors present a case of ruptured interstitial ectopic pregnancy confined to the leaves of broad ligament, with atypical presentation and radiological features which led to difficulty in diagnosing the interstitial ectopic pregnancy. After laparoscopic confirmation of ruptured interstitial ectopic pregnancy, the patient was managed successfully by laparoscopic cornual resection.


Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28(6):1661-71.

Chukus A, Tirada N, Restrepo R, Reddy NI. Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics. 2015;35(3):946-59.

L. LTW. Cornual (interstitial) ectopic pregnancies (IEP) in second trimester. BJOG An Int J Obstet Gynaecol. 2012;119:247.

Parker RA, Yano M, Tai AW, Friedman M, Narra VR, Menias CO. MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics. 2012;32(5):1445-60.

Rizk B, Holliday CP, Abuzeid M. Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies. Middle East Fertility Society Journal. 2013;18(4):235-40.

Constance ES, Moravek MB. Diagnosis and Management of Ectopic Pregnancy. Handbook of Gynecology. 2017:291-304.

Duong D, Baker WE, Adedipe A. Clinician-performed ultrasound diagnosis of ruptured interstitial pregnancy. The American journal of emergency medicine. 2009;27(9):1170-e1.

Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 1993;189(1):83-7.

Jermy K, Thomas J, Doo A, Bourne T. The conservative management of interstitial pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology. 2004;111(11):1283-8.

Hiersch L, Krissi H, Ashwal E, From A, Wiznitzer A, Peled Y. Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2014;54(6):576-80.

Liao CY, Tse J, Sung SY, Chen SH, Tsui WH. Cornual wedge resection for interstitial pregnancy and postoperative outcome. Aust New Zeal J Obstet Gynaecol. 2017;57(3):342-5

Grindler NM, Ng J, Tocce K, Alvero R. Considerations for management of interstitial ectopic pregnancies: Two case reports. J Med Case Rep. 2016;10(1):106.






Case Reports