Coexistence of Right Tubal Ectopic Pregnancy and Parasitic Fibroid in Anterior Abdominal Wall and Broad Ligament: A Rare Surgical Encounter.

BACKGROUND

Parasitic fibroids are rare extrauterine leiomyomas that can arise spontaneously or following prior uterine surgery, particularly with morcellation. Their coexistence with ectopic pregnancy is exceptionally rare and presents a unique surgical challenge. We report a rare case of concurrent right tubal ectopic pregnancy, broad ligament fibroid and anterior abdominal wall parasitic fibroid.

CASE PRESENTATION: A 30-year-old woman (P0 + 2) presented with acute right iliac fossa pain and a serum β-hCG level > 9000 IU/L. She had a history of two prior laparoscopic myomectomies. Transvaginal ultrasound suggested a right adnexal ectopic pregnancy with a large posterior uterine fibroid and free pelvic fluid. Laparoscopy revealed an unruptured right tubal ectopic pregnancy, a fibroid in the broad ligament and a separate parasitic fibroid attached to the anterior abdominal wall. A laparoscopic right salpingectomy, excision of the parasitic fibroid and adhesiolysis were performed. Histology confirmed ectopic pregnancy and parasitic leiomyoma. The patient had an uneventful recovery.

DISCUSSION: The simultaneous occurrence of ectopic pregnancy and parasitic fibroids is highly unusual. Prior myomectomies, especially those involving morcellation, may predispose patients to parasitic fibroid formation through iatrogenic tissue implantation. In this case, distorted pelvic anatomy due to adhesions and fibroids may have contributed to tubal implantation of the embryo. This case highlights the rarity of parasitic fibroids and emphasises the importance of preventive measures during myomectomies, such as contained morcellation to avoid implantation of parasitic fibroids. While intraoperative mindfulness is important, parasitic fibroids are an uncommon finding and are not a routine consideration during common gynaecological presentations, such as ectopic pregnancy.

CONCLUSION

This case illustrates a rare but significant intersection of fibroid pathology and ectopic pregnancy. Awareness of parasitic fibroids in patients with prior fibroid surgery is essential for surgical planning and optimising reproductive outcomes. Further investigation into the pathophysiological mechanisms linking fibroid surgery to altered fertility and ectopic gestation is warranted.