Wrong turn—dead end



We were most interested by the recent articles by Kent and colleagues (Vol 107, May 2000)1, proposing the phenomenon of transperitoneal migration of sperm. In this article the authors describe a case of successful reversal of sterilisation on the right which was not attempted on the left due to the lack of patency of the proximal part of the uterine tube. She subsequently went on to develop an ectopic in the distal remnant of the left tube which was excised laparoscopically.

We write in support of their recommendation of total salpingectomy, including fimbrial ends of an affected tube, when reanastomosis is not possible, and also in support of the theory originally proposed by Ansari and Miller2 of transperitoneal spermatozoa migration following partial salpingectomy.

A thirty year old woman was admitted under our care with a suboptimal rise in human chorionic gonadotrophin hormone and a transvaginal ultrasound scan showing an empty uterus with a right-sided ectopic pregnancy. This was confirmed at surgery and a right salpingectomy was performed. The left tube and ovary appeared normal. Histology confirmed an ectopic pregnancy.

Six months previously, the same patient had presented shocked, with a ruptured ectopic pregnancy in the isthmic portion of the right tube and had undergone a laparotomy with removal of the affected part of the tube. A distal lump was left. Our experience in this case supports the theory of transperitoneal migration of spermatozoa and highlights the sequelae of leaving distal stumps. Our practice in the management of ectopic pregnancy where salpingectomy is required is to perform a total salpingectomy, where reimplantation of the remaining portion of the tube as an interval procedure is felt impossible.