Extremely large tubal ectopic pregnancy with tubal torsion: an extraordinary case report

Objective

Ectopic pregnancy is defined as the implantation of a fertilized egg anywhere outside the uterine cavity. The incidence of ectopic pregnancy is estimated to be between 1% to 2% of all pregnancies. We report a big tubal ectopic pregnancy case with tubal torsion.

Case(s)

A 36-year-old woman, gravida 4, parity 2, curettage 1 admitted to Kanuni Sultan Suleyman Education and Research Hospital emergency room with severe abdominal pain. She had mild vaginal bleeding and nausea. Physical examination revealed tenderness of abdomen. The patient` s blood pressure was 90/60mmHg, pulse rate was 120 beat/min, respiratory rate and body temperature was 16/Min, 37.60C respectively. Generalized abdominal tenderness was noted during palpation and speculum examination revealed slight bleeding through cervical os.
Trans abdominal sonography revealed a gestational sac with a live fetus measured at 12th gestational week, located at the superior surface of the uterine fundus (arrow). Ectopic pregnancy mass was measured 8x5 cm on widest diameter (Figure 1).
After the first emergent investigation, decision for an operation had been given with the pre-diagnosis of an abdominal pregnancy or ruptured ampullary pregnancy.
Due to hemodynamic instability and gross abdominal bleeding, laparotomy was decided. Intraoperatively 1 liter of hemoperitonium was seen. In the right fallopian tube, an ectopic pregnancy which is 75x45 mm in size (arrowhead) and with the fallopian tube torsed one complete round (arrow). When salpingectomy material was examined, the fetus’ crown-rump length was measured 59 mm’s, which is competible to 12 weeks and 3 days of gestational age (figure 2).

Conclusion

It is possible for ampullary ectopic pregnancies to progress until 13th week of gestation. Torsional involvement caused by the excessive growing of the mass can contribute to worsening of the pain in the groin. The differential diagnosis with abdominal pregnancies can be supported by MRI but operational diagnosis may be considered as urgent laparotomy is crucial in some cases

Keywords

Ectopic Pregnancy, Tubal Torsion, Abdominal Pregnancy

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