Dr Ting is correct. We were referring to the management of an interstitial pregnancy. The term cornual ectopic pregnancy refers to an ectopic pregnancy that has implanted in the interstitial portion of the fallopian tube.1 Transvaginal sonography was helpful in the diagnosis but not conclusive. In our case, the suspicion of a cornual (interstitial) pregnancy arose because the endometrial stripe was only visualised lateral to the gestational sac, which was surrounded by very thin myometrium. The diagnosis was confirmed both by hysteroscopy and by laparoscopy. Indeed, at hysteroscopy, a partial view of the gestational sac was obtained, suggesting a possible partial endocornual involvement.
We are conscious that the diagnosis is difficult and questionable especially if, as in our case, the gestational sac is partially visible at hysteroscopy. We agree that this kind of pregnancy is not always as easily removed by suction curettage. We can only speculate on the reasons. Perhaps our interstitial pregnancy developed partially in the most lateral part of the uterine cavity. After removal of the gestational sac, during hysteroscopy, the interstitial part appeared dilated with some placental debris. Such uterine distortion was clearly visible by laparoscopy as well. We performed a resection of the dilated interstitial area and adjacent right cornual endometrium to be sure that no remaining gestational debris was left.
Cornual endometrial resection including the tubal ostium can be successfully performed without perforation of the uterus in expert hands. It is safe because although we were operating interstitially, the resectoscopy was performed under laparoscopic control. In case of cornual rupture, it could have been sutured laparoscopically. We recommend an interesting article by Jain et al.2