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Case Report
A tale of two laparoscopies: Diagnosing and treating a challenging case of interstitial ectopic pregnancy
1 East Sussex, Brighton South England, UK
2 District headquarters hospital Attock , Pakistan
3 University hospital Sussex NHS, UK
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Aima Athar
East Sussex, Brighton, South England, BN2 5BE,
UK
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Article ID: 100229Z08AA2026
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Athar A, Khannum W, Ajala T. A tale of two laparoscopies: Diagnosing and treating a challenging case of interstitial ectopic pregnancy. J Case Rep Images Obstet Gynecol 2026;12(1):38–44.ABSTRACT
Introduction: Interstitial ectopic pregnancy (IEP) is a rather uncommon but potentially life-threatening type of ectopic implantation with a high-risk of delayed diagnosis and severe morbidity of the mother. It is usually complicated by the presence of typical clinical presentation and inconclusive early-term imaging, which makes it difficult to detect timely.
Case Report: we describe the case of a non-pregnancy female, aged 26 years, who reported at six weeks of gestational age with intermittent abdominal pain at the lower part and increased 8-hCG levels. The first transvaginal ultrasound was unable to localize the pregnancy and laparoscopy performed initially was inconclusive. The continued symptoms and the increasing level of the 2 hCG stimulated additional investigation by use of the magnetic resonance imaging, MRI, which revealed a lesion typical of interstitial ectopic pregnancy. A second laparoscopy made the diagnosis and allowed surgical resection. Because of the persistent 50 of 2-hCG postoperative, adjunctive methotrexate treatment was given with total resolution.
Conclusion: The case raises the issue of the complexity of diagnosis of interstitial ectopic pregnancy, especially in patients whose pelvic anatomy is altered. It highlights the value of keeping a high level of suspicion, the supplementing nature of MRI in cases where investigations within the first stage are inconclusive and the value of a combination of surgical and medical treatment in the final results.
Keywords: β-hCG, Diagnostic laparoscopy, Interstitial ectopic pregnancy, Intramural pregnancy, Methotrexate, Minimally invasive surgery
SUPPORTING INFORMATION
Author Contributions
Aima Athar - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Wajiha Khannum - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tosin Ajala - Acquisition of data, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthor declares no conflict of interest.
Copyright© 2026 Aima Athar et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
