Ruptured ectopic pregnancy with unusual presentation: a case report and review of the literature

Abstract

Author(s): Swati Singh, Elhadi Miskeen*, Dalia Alqarni, Reema Alsaluli, Amirah Alqawba, Maha Alaklabi, Nawaf Alqarni, Shahad Alaklabi, Turki Alqarni, Lamis Almisha, Abdullah M. Alshahrani, Reyam Faisal, Turki Mohamed Alaklabi and Abdullah Hassan Alhalafi

Ectopic pregnancy is a life-threatening condition that occurs when a fertilized egg implants outside the uterine cavity. While the classical presentation involves abdominal pain, vaginal bleeding, and amenorrhea, atypical manifestations can pose diagnostic challenges and lead to delayed intervention. We presented a case of a 26-year-old G2P1+0 female with a history of cesarean section nine months ago. She gave with ten days of lower abdominal pain and brownish vaginal discharge but without the classical triad of symptoms. She exhibited signs of distress on examination, and her pulse and blood pressure were elevated. Transvaginal ultrasonography revealed an empty uterus with a heterogeneous area in the pouch of Douglas. A diagnosis of ruptured ectopic pregnancy was made based on clinical and imaging findings, and exploratory laparotomy confirmed a ruptured right tubal ectopic pregnancy.
Additionally, bleeding was observed from tissue attached to the lower posterior part of the uterus, which was excised during surgery. This case highlights the importance of considering atypical presentations of ectopic pregnancy and the necessity of timely diagnosis and intervention to prevent adverse outcomes. Healthcare providers should maintain a high index of suspicion for ectopic pregnancy, especially in women with positive pregnancy tests and pelvic symptoms, even without the classical triad.
 

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