Abstract
INTRODUCTION: Intramural ectopic pregnancy (IMP) refers to the implantation and implantation of a gestational sac in the uterine muscle layer, which is a rare and potentially life-threatening disease. Early detection and diagnosis are significant, and treatment methods are often challenging. PRESENTATION OF CASE: We report a case of IMP after embryo transfer in a 38-year-old woman. The patient developed persistent ectopic pregnancy after combined hysteroscopic and laparoscopic surgery. Intramuscular injection of methotrexate did not have a significant effect, and transabdominal ultrasound-guided in situ injection of methotrexate at the site of the lesion was performed with a significant impact. DISCUSSION: This case emphasizes the complexity of the treatment of IMP. Surgery alone may not allow complete excision of the lesion, and residual chorionic tissue may invade the muscular vessels; this case emphasizes the importance of postoperative drug therapy. CONCLUSION: IMP invades the myometrium in a widely spreading manner, and methotrexate injection in situ at the site of the lesion after conservative surgery may become an efficacious treatment modality.