Paratubal hematocele

Specialty: Gynecology and breast.

• Peritubaric encapsulated blood
• fallopian tube hematoma
• unilateral adnexal blood collection

Why it occurs

• Incomplete tubal abortion with slow and persistent bleeding through the fimbria into the paratubal space in an unruptured ectopic pregnancy
• Contained rupture of the wall of the fallopian tube due to ectopic pregnancy
• Trauma or rupture of paratubal vessels during vigorous ovulation or prior surgical manipulation

Initial workup

Quantitative determination of serial serum beta-hCG (essential for the diagnosis of ectopic pregnancy). High-resolution transvaginal ultrasound (an adnexal mass with a heterogeneous appearance and imprecise limits is evident adjacent to the ovary, with absent or low-resistance peripheral Doppler, compatible with accumulated clots). Serial blood count to monitor hemodynamic stability.

Standard management

• Methotrexate in a single dose of 50 mg/m² intramuscularly if it is a clinically stable unruptured tubal ectopic pregnancy, with low beta-hCG levels (<5000 IU/L), absence of embryonic heartbeat by ultrasound, mass less than 3-4 cm and without signs of active massive hemoperitoneum. Moderate pain is controlled with regular analgesics (avoiding strong NSAIDs if Methotrexate is used due to the risk of kidney toxicity). If there is instability or refractoriness to treatment with methotrexate, laparoscopic surgical salpingectomy is indicated (note: the decrease in beta-hCG must be strictly monitored on days 4 and 7 after Methotrexate injection).