{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T17:20:44Z","timestamp":1772644844342,"version":"3.50.1"},"reference-count":11,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,13]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>An ectopic pregnancy in a retroperitoneal location is an extremely rare and life-threatening situation. Here, we present a case report of a nulliparous woman in her 30s who presented with rising \u03b2-human chorionic gonadotropin (hCG) titre after embryo transfer but with no pregnancy detected on transvaginal scan. She was referred to us after two negative laparoscopies done outside and finally an MRI revealing a retroperitoneal pregnancy embedded close to the aorta near the origin of the left renal artery. As parenteral methotrexate had no effect, an ultrasound-guided intrasac methotrexate instillation was done. Though the hCG levels fell to near normal levels, the sac did not regress and seemed to increase in size. Laparoscopic removal was attempted, but the intraoperative bleeding necessitated an open procedure. This case highlights the diagnostic difficulty, limitations of systemic methotrexate in retroperitoneal ectopic pregnancies and the need for individualised multidisciplinary management.<\/jats:p>","DOI":"10.1136\/bcr-2025-271658","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:40:29Z","timestamp":1772631629000},"page":"e271658","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges in diagnosis and management of a retroperitoneal pregnancy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8223-5780","authenticated-orcid":false,"given":"Sudha","family":"Sumathy","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepthi","family":"Sureshkumar","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Amrita Vishwa Vidyapeetham Amrita Health Sciences Campus, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Manish","family":"Nair","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Amrita Vishwa Vidyapeetham Amrita Health Sciences Campus, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgie","family":"Mathew","sequence":"additional","affiliation":[{"name":"Urology, Amrita Vishwa Vidyapeetham Amrita Health Sciences Campus, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"2026030405402049000_19.3.e271658.1","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1186\/s12884-023-05909-7","article-title":"Retroperitoneal ectopic pregnancy: successful expectant management in condition of early pregnancy failure","volume":"PMCID","author":"Le","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026030405402049000_19.3.e271658.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2018.12.016"},{"key":"2026030405402049000_19.3.e271658.3","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ejogrb.2024.04.037","article-title":"Subserosal pregnancy: Systematic review with proposal of new diagnostic criteria and ectopic pregnancy classification","volume":"297","author":"Stabile","year":"2024","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2026030405402049000_19.3.e271658.4","doi-asserted-by":"crossref","first-page":"3000605251375215","DOI":"10.1177\/03000605251375215","article-title":"Retroperitoneal ectopic pregnancy localized to the mesorectum: A case report and mini-review of literature","volume":"53","author":"Liu","year":"2025","journal-title":"J Int Med Res"},{"key":"2026030405402049000_19.3.e271658.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2018.05.027"},{"key":"2026030405402049000_19.3.e271658.6","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.2147\/IJWH.S486185","article-title":"A Case Report of Retroperitoneal Ectopic Pregnancy and Review of Literature","volume":"16","author":"Xia","year":"2024","journal-title":"Int J Womens Health"},{"key":"2026030405402049000_19.3.e271658.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2021.02.014"},{"key":"2026030405402049000_19.3.e271658.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-04799-5","article-title":"Multidisciplinary treatment of retroperitoneal ectopic pregnancy: a case report and literature review","volume":"22","author":"Xu","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026030405402049000_19.3.e271658.9","article-title":"Retroperitoneal Ectopic Pregnancy: Diagnosis and Therapeutic Challenges","volume":"2017","author":"Ouassour","year":"2017","journal-title":"Case Rep Surg"},{"key":"2026030405402049000_19.3.e271658.10","doi-asserted-by":"crossref","first-page":"4540","DOI":"10.1016\/j.radcr.2025.05.091","article-title":"Retroperitoneal ectopic pregnancy: A case report","volume":"20","author":"Tinh","year":"2025","journal-title":"Radiol Case Rep"},{"key":"2026030405402049000_19.3.e271658.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2021.05.106"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271658","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:40:31Z","timestamp":1772631631000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,4]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bcr-2025-271658"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271658","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}