Diagnostic Challenges in Ruptured Ovarian Ectopic Pregnancy: A Case Report

Abstract

Ovarian ectopic pregnancy (OEP) is a rare condition with a potentially fatal outcome and is notoriously difficult to diagnose. We present a case of a 21-year-old primigravida at about four weeks of gestation, presenting with lower abdominal pain and vaginal bleeding. On clinical evaluation, the patient was pale and tachycardic, with laboratory investigations confirming anaemia and an elevated serum beta-human chorionic gonadotropin (b-hCG) level of 1670 mIU/L. Transvaginal sonography was imprecise, suggesting a ruptured left adnexal ectopic pregnancy. The patient was taken up for emergency laparotomy, which revealed hemoperitoneum with normal bilateral fallopian tubes & right ovary and a ruptured left ovary with adherent products of conception. A diagnosis of ruptured left ovarian ectopic pregnancy was made, and the surgery was proceeded with left ovarian wedge resection. Histopathological evaluation revealed the presence of chorionic villi interspersed within ovarian stroma, confirming the diagnosis in accordance with Spiegelberg criteria. The postoperative course was uneventful with b-hCG normalisation by postoperative day ten. This case illustrates the shortcomings of ultrasonography alone as a diagnostic modality for OEPs and emphasises the importance of early detection and prompt surgical intervention for a favourable prognosis.