Case presentation
A 32-year-old female, gravida 5, para 4, aborta 1, presented to the
Department of Obstetrics and Gynecology with severe lower abdominal pain
that began approximately one day ago and had progressively worsened. The
last menstrual period (LMP) was 40 days ago with a medical history of
left Fallopian tube pregnancy a year ago, which was successfully managed
by oophorectomy and salpingectomy of the left side. Previous pregnancies
resulted in uncomplicated spontaneous vaginal deliveries. No history of
tobacco, alcohol, allergies, or medications was reported. The vital
signs were measured (Blood pressure:100/60 mm Hg, pulse rate: 110/min,
and BMI: 21 kg/m2). Laboratory findings were as
following: Hemoglobin 10.3 g/DL, Hematocrit: 28.1%, Leukocyte count:
20.5/µm, Neutrophils: 90%, Platelets: 357 /µm, β-HCG: 7503 IU/L).
Vaginal examination revealed a closed cervix with no vaginal bleeding,
but tenderness to palpation and motion. Ultrasound demonstrated an empty
uterus with decidual reaction, and a visible gestational sac located in
the left cornu, the 5th-weeks’ gestational sac in size (Fig.1), with a
moderate amount of peritoneal fluid in Douglas Pouch extends to Morris
pouch. An emergency exploratory laparotomy was performed via a
Pfannenstiel incision. A ruptured gestational sac located in the left
cornu was found, complicated by severe bleeding filling the peritoneal
cavity which was suctioned (Fig.2 A, B). The products of conception,
gestational sac, and left cornu were successfully eradicated (Fig.3 A,
B), (Fig.4). The Z Z drainage has been placed in Douglas’s pouch and
removed one week after surgery. One unit of blood was transfused during
surgery. Pathological findings confirmed the diagnosis of ectopic
pregnancy (Fig.4). The postoperative period was unremarkable; the
patient was discharged 24 h after the surgery in a hemodynamically
stable state. One year of follow-up, there were no long-term
complications. However, the patient uses oral contraceptives to prevent
pregnancy.