Ruptured Right Broad Ligament Ectopic Pregnancy in a Patient With Prior Right Salpingo-Oophorectomy: A Case Report.

Erum Azhar,Salma Mohammadi,Landen Green,Abdul Waheed

doi:10.7759/cureus.8276

Abstract

Ectopic pregnancy can be a life-threatening cause of acute abdomen. Broad ligament pregnancy accounts for 1% of ectopic abdominal pregnancies and complications can be calamitous. This case report highlights a 27-year-old G2P0010 female who presented with amenorrhea and acute right lower quadrant and pelvic pain. By last menstrual period (LMP), she was at seven weeks and two days gestation. Her past surgical history was significant for a prior right salpingo-oophorectomy. The physical examination was significant for severe right lower quadrant tenderness with guarding. The urine pregnancy test was positive with the serum quantitative beta-human chorionic gonadotrophin (Beta hCG) of 28011 MIU/ML (normal range <5 MIU/ML). The transvaginal ultrasonography demonstrated an empty uterus and a gestational sac containing a fetal pole in the right adnexal area. The crown-rump length was 7.2 mm, consistent with six weeks and four days, with a positive fetal heart rate and moderate free fluid in the cul-de-sac. The patient was taken for immediate diagnostic laparoscopy, which was converted to open laparotomy due to active bleeding from the right broad ligament and pelvic wall close to large pelvic vessels. In addition to the hemoperitoneum, intraoperative findings revealed a normal left fallopian tube and ovary and absent right fallopian tube and ovary. Right ureterolysis was done and hemostasis of the bleeding broad ligament and right pelvic sidewall was established. An adherent tissue was dissected from the right broad ligament and sent to pathology. The patient did well postoperatively. The final pathology showed an ectopic pregnancy with immature chorionic villi in the broad ligament. The diagnosis of ectopic pregnancy in the broad ligament is challenging. The location could be close to the major pelvic vessels and anatomic structures like the ureter and bowel, hence, it can cause massive hemorrhage with maternal morbidity and mortality. Diagnosis is often missed preoperatively and made intraoperatively. Hence, we emphasize that this differential be considered in reproductive-aged women who present with atypical presentations of acute abdomen and amenorrhea.

Highlights

Ectopic pregnancy is defined as the implantation of the fertilized egg outside the endometrial cavity of the uterus
Abdominal pregnancy is reported in the literature at different anatomic sites, including the broad ligament, the pouch of Douglas, pelvic sidewall, spleen, bowel, omentum, and at different gestational ages [2,5,6,7]
The location of the abdominal pregnancy could be close to the major pelvic vessels and anatomic structures, like the ureter and bowel, can cause massive hemorrhage and maternal morbidity

Summary

Introduction

Ectopic pregnancy is defined as the implantation of the fertilized egg outside the endometrial cavity of the uterus. Her obstetrical history demonstrated one prior incomplete abortion at seven weeks gestation one and a half years prior, necessitating a dilatation and curettage Her gynecological history was significant for a prior laparoscopic salpingo-oophorectomy one-year ago at another hospital for torsion of right adnexal mass that revealed endometriotic ovarian cyst and paratubal cyst of the fallopian tube on pathology. Since her last surgery, she had not been using any form of contraception. Microscopic evaluation revealed rare immature chorionic villi in the broad ligament and no fallopian tube tissue (Figure 5) She was followed postoperatively at two weeks and six weeks as well and received Depo-Provera for contraception

Discussion

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Disclosures