Abdominal Ectopic Gestation In The Second Trimester At A District Hospital: A Rare Case

Abstract

Introduction: Abdominal ectopic pregnancies are uncommon forms of ectopic pregnancies. They might be unnoticed until late in pregnancy and are associated with an increased risk of maternal complications and mortality. This is a case report of an abdominal ectopic gestation diagnosed at the first visit to a district hospital in Ghana and how it was managed in a low-resource setting.
 Case Presentation: A 28-year-old gravida 4 parity 3, presented with 4 months history of amenorrhoea associated with recurrent bleeding per vaginum. Ultrasound showed a slightly bulky uterus with very scanty echogenic material within the endometrial cavity. There was however a right adnexal gestational sac with a live foetus at 19 weeks + 4 days and no free fluid was seen in the pouch of Douglas. The patient was counselled and prepared for an emergency exploratory laparotomy and intraoperative findings showed normal size uterus of about 8 weeks in size with an unruptured right adnexae gestation. The gestational sac was in the region of the right ovary which could not be visualised and attached to the uterus via the ovarian ligament with a normal-looking right tube. Post-operative recovery was uneventful and she was discharged three days later. 
 Conclusion: Abdominal ectopic gestation can pose a diagnostic challenge, particularly in low-resource settings. There is a need for clinicians to have a high index of suspicion and provide timely surgical intervention necessary to reduce complications and mortality associated with the condition.