Retroperitoneal ectopic pregnancy: is there any place for non-surgical treatment with methotrexate?

Cases of retroperitoneal ectopic pregnancy are very rare. To date, few published and unpublished reports are available and no clear or specific management guidelines have been defined. Despite concern for the risk of surgical resection of the gestational tissue and associated hemorrhage when these lesions are in close proximity to the large retroperitoneal blood vessels, conservative treatment with methotrexate has so far failed to obviate the ultimate need for surgical management. A case of retroperitoneal ectopic pregnancy located very close to large retroperitoneal blood vessels and treated with methotrexate is presented. Two other varying cases of failed methotrexate treatment for similar diagnosis are discussed. The presented patient failed methotrexate treatment and eventually underwent surgical excision.