Case report: Tubal stump ectopic pregnancy.

Abstract

Background: Ectopic pregnancies (EP) account for 1-2% of all pregnancies but are the most common cause of death in the first trimester. Tubal stump EPs make up 0.4% of ectopic pregnancies. Case: A 28-year-old female presents with sudden-onset right lower quadrant pain. She has previously had one tubal ectopic, managed with histologically verified right salpingectomy. Her bHCG was 1588 IU/L. Ultrasound was suspicious for ruptured right-sided ectopic pregnancy with a corpus luteum on the left ovary. Laparoscopy was performed due to severe ongoing pain. A large organised clot was seen adhered to the right tubal stump and removed, revealing an actively bleeding but otherwise normal appearing tubal stump. The tubal remnant was diathermised and washout of haemoperitoneum performed. Discussion(s): Tubal stump EPs are a rare and potentially life-threatening event and diagnosis is often delayed. It is likely in this case that a spontaneous abortion had already occurred and deposited in the adhered clot, allowing for diathermy to the tubal remnant alone. Histological sampling was not possible and therefore we have recommended this patient track her bHCG to 0.