A rare cause of hemorrhagic shock

Abstract

A 16-year-old girl, previously healthy and without a relevant family history, was admitted to Emergency Department for sudden and intense abdominal pain in the lower quadrants with four hours of evolution associated with vomiting and a liquid dejection. She denied fever, dysuria or another symptom. She also denied the onset of sexual activity and her last menstrual period occurred three weeks before admission. She was taken a combined oral contraceptive. On physical examination, she was tachycardic, hypotensive and had a capillary filling time of 4 seconds. The abdomen was painful especially in the right lower quadrant with peritoneal irritation signs. The blood workup revealed: hemoglobin: 10,8 g/dL, leukocytes: 28,850/µL (N:85,3% and L:9%) and a serum hormone human chorionic gonadotropin of 1124,7 mUI/mL. She performed an abdominal-pelvic CT scan that revealed an abundant amount of intraperitoneal fluid with spontaneously dense areas compatible with hemoperitoneum. Extravasation of iodinated contrast in the right adnexal area suggested the diagnosis of ruptured tubal ectopic pregnancy. The patient underwent emergency surgical salpingectomy with good clinical evolution. Ectopic pregnancy is a pregnancy in which the implantation of the blastocyst occurs outside the endometrium. Risk factors include fallopian tube injuries, previous surgeries, previous ectopic pregnancy, the early beginning of sexual activity and multiple sexual partners. The classic triad of ectopic pregnancy includes abdominal pain, amenorrhea, and vaginal bleeding. However, manifestations of the disease may vary considerably from being asymptomatic to haemodynamically compromised. The authors pretend to report a rare cause of abdominal pain in adolescence that should be considered even when sexual activity is denied, in order to prevent a potentially fatal outcome.