A rare cause of surgical abdomen: Heterotopic pregnancy rupture

Abstract

Heterotopic pregnancy is simultaneous extrauterine and intrauterine localization of the fertilized ovum. In this article, we aimed to present the case of a ruptured heterotopic pregnancy patient who had abortion a week ago. A 28-year-old female patient was referred to the Emergency Department due to vaginal bleeding and abdominal pain. Physical examination revealed that the patient, who had an abortion a week ago because of unwanted pregnancy at the 7th gestational week, had widespread sensitivity in the abdomen. Active bleeding was observed in vaginal examination. Her serum β-human chorionic gonadotropin level was 14562 mIU/mL. A fetus surrounded by hematoma with an 8 mm crown-rump length and heartbeat was observed in the right adnexal area during pelvic ultrasonography. The patient was diagnosed with ruptured heterotopic pregnancy and underwent surgery. In female patients who are in reproductive age and who refer to Emergency Department with acute abdominal pain and vaginal bleeding, it must not be ignored that there might be extrauterine pregnancy along with intrauterine pregnancy and/or rupture. Ectopic pregnancy is a disease, which might occur in sexually active women in reproductive period and develops as a result of abnormal implantation of blastocyst. It can be localized in the ovaries, and less commonly, in the fallopian tubes. Ovarian pregnancy is characterized with the blastocyst being implanted in the ovary. It constitutes 0.15-3% of ectopic pregnancies and is observed in approximately one in every 7000 pregnancies. In our case, the blastocyst was localized in the right ovarian area, which is exceedingly rare.