Introduction: A cornual ectopic pregnancy is a pregnancy that develops in the interstitial portion of the fallopian tube invading through the uterine wall. As myometrium is more distensible than fallopian tube, cornual pregnancies often rupture later than other tubal pregnancies. Cornual pregnancy accounts for 2–4% of ectopic pregnancies and have a mortality rate of 2.0–2.5%. It is usually associated with high vascularity, which may result in severe hemorrhage and death. Early diagnosis is important, as it not only allows preventing deadly complications, but allows various choices of treatment options and possibility of preserving fertility. Usually, it is managed by laparotomy and resection of cornual pregnancy. Here, we present successful laparoscopic resection for cornual ectopic pregnancy.

Objective: To determine the feasibility of laparoscopic surgery for cornual ectopic pregnancy.

Case Study: A 40 years old lady, Gravida 4 Para 3, with eight week of period of amenorrhoea, presented with vaginal spotting and lower abdominal pain. She also had a previous Lower Segment Caesarean Section and a BMI of 44 kg/m2. The challenge in this case was to attempt laparoscopy in a previously operated patient who presents with severe obesity (Obese III).

Ultrasound examination showed left cornual ectopic pregnancy measuring 4×4 cm. The fetus was viable with crown rump length 20.7 mm (8 wks). She underwent diagnostic laparoscopy after thorough counselling for surgical procedure and its related complications including possibility of hysterectomy during surgery. Intraoperatively,   left cornual ectopic pregnancy, bulky uterus, normal fallopian tubes and ovaries were seen. No haemoperitoneum noted. After diluted Adrenalin was injected at the uterine wall medial to the cornual pregnancy, laparoscopic left cornual resection together with left fallopian tube and right salphingectomy for sterilization were done as the couple completed their family. The postoperative period was uncomplicated and she was discharged home on the second day. Histopathological examination of the specimen confirmed the diagnosis.

Conclusion: The diagnosis of cornual ectopic pregnancy can be made with careful early first trimester ultrasound examination. Even intrauterine gestational sac is seen at sagittal view, one must pay attention at the coronal view to detect the cornual pregnancy.  The index of suspicion must be raised if intrauterine gestational sac is visible at the one cornu of the uterus at the coronal view of uterus.  Early diagnosis and prompt treatment is essential to reduce morbidity and mortality due to cornual pregnancy.  Laparoscopic resection for cornual ectopic pregnancy is possible with or without vasoconstriction agent in the hands of confident and experienced laparoscopic surgeon and has the advantage of preserving uterus for couple who wish for future fertility.