Tubal ectopic pregnancy

Case contributed by Dr Maulik S Patel

Presentation

Mild lower abdominal pain for the last few days. An IUD was removed 16 days back. Previous one LSCS about 4 years back.

Patient Data

Age: 30 years
Gender: Female

1st study

Ultrasound

The uterine endometrial cavity is empty. There is a heterogeneous echopattern lesion (about 40 x 35 x 30 mm) in the left adnexa separate from the left ovary. There was no internal vascularity. Both ovaries are normal. There is mild free fluid with echoes in the pelvis.

2nd study 48 hours later. The patient presented with severe abdominal pain.

Ultrasound

The previously mentioned findings are present. An additional finding is free fluid in the hepatorenal region.

Photo

The laparoscopy revealed a left tubal abortion. The left fallopian tube was intact. There was blood coming out through the fimbria. Milking of the tube was done to remove blood clots. Due to internal bleeding from the implantation site in the tubal mucosa, hematosalpinx reappeared resulting in continuous trickling of blood from the fimbria. Left salpingectomy was done.

Case Discussion

A female presented with mild lower abdominal pain with a history of recent IUD removal. Ultrasound shows left hemetosalpinx with a small amount of free fluid in the pelvis. After the ultrasound, a urine pregnancy test was done which was negative. However, serum beta HCG level was between 500 to 600 milli-international units per milliliter. The patient was treated conservatively with methotrexate. There was increased pain after 48 hours. A repeat ultrasound showed increased hemoperitoneum. Laparoscopy was done with findings as mentioned above. Histopathology confirmed the tubal ectopic pregnancy.

Surgical details and intraoperative photos courtesy: Treating Dr. Drashti Patel.

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