Intramyometrial Gestation: A Rare Localization of Ectopic Pregnancy

Intramyometrial pregnancy is the rarest subtype of ectopic pregnancy. It poses a diagnostic and therapeutic challenge. Preoperative diagnosis is difficult and hysterectomy may be required due to delay in diagnosis. Misdiagnosis can lead to uterine rupture with life threatening haemorrhage. We report a rare case of intramyometrial ectopic in a 27 year old lady, P3L3 with no history of previous abortions. Patient was admitted at 8 weeks of gestation with pelvic pain and haemorrhage. She underwent ultrasound pelvis and MRI pelvis which revealed an intramyometrial ectopic gestation. Findings on diagnostic laparoscopy revealed an asymmetrically enlarged anterior wall of uterus. Hysteroscopy was performed concurrently demonstrating an empty uterine cavity. Medical management was adopted with methotrexate. She was followed up until the Beta HCG levels returned to baseline. This case report illustrates the imaging findings of an exceptional case of intramyometrial ectopic pregnancy.