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.