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. 2022 May;6(2):129-132.
doi: 10.5811/cpcem.2022.2.54929.

Ultrasound in the Emergency Department Identifies Ectopic Pregnancy Post Hysterectomy: A Case Report

Allison Cohen  1 , Dorothy Shi  1 , Evan Keraney  1 , Brendon Stankard  1 , Mathew Nelson  1
Affiliations

Ultrasound in the Emergency Department Identifies Ectopic Pregnancy Post Hysterectomy: A Case Report

Allison Cohen et al. Clin Pract Cases Emerg Med. 2022 May.

Abstract

Introduction: Ruptured ectopic pregnancy is one of the leading causes of maternal death. Point-of-care ultrasound (POCUS) has been shown to be highly sensitive for excluding ectopic pregnancy. Ectopic pregnancy after a hysterectomy is a rare but life-threatening occurrence. We present a case where POCUS helped to diagnose a post-hysterectomy ectopic pregnancy.

Case report: A 36-year-old female with a prior surgical history of hysterectomy without oophorectomy presented to the emergency department with lower abdominal pain. A POCUS revealed free fluid in the right upper quadrant with an unremarkable gallbladder. Subsequently, the pelvic POCUS noted free fluid as well as a heterogeneous structure in the right adnexa. The clinician ordered a serum beta human chorionic gonadotropin level, which was 173.2 international units per milliliter (lU/mL) (negative: < 5m IU/ml). Transvaginal ultrasound revealed a right adnexal echogenic structure with surrounding vascularity and moderate, complex free fluid suggestive of hemorrhage. Given the concern for possible ectopic pregnancy, obstetrics took the patient to the operating room where a right tubal ectopic pregnancy was confirmed.

Conclusion: A ruptured ectopic pregnancy is a life-threatening condition that requires rapid diagnosis. Ectopic pregnancy post hysterectomy is an uncommon occurrence infrequently considered in the differential diagnosis of lower abdominal pain, leading to considerable delays in diagnosis. Although uncommon, emergency clinicians must consider this diagnosis in female patients with lower abdominal pain.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
A point-of-care ultrasound view of the right upper quadrant showing free fluid (arrow) between the liver (star) and kidney.
Image 2
Image 2
Point-of-care ultrasound of the pelvis in transverse view showing a complex structure (arrow) adjacent to the right ovary (star).
See this image and copyright information in PMC

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References

    1. Fylstra DL. Ectopic pregnancy after hysterectomy: a review and insight into etiology and prevention. Fertil Steril. 2010;94(2):431–5. - PubMed
    1. Villegas E, González-Mesa E, Benítez MJ, et al. Tubal ectopic pregnancy two years after laparoscopic supracervical hysterectomy. BMC Womens Health. 2014;14:69. - PMC - PubMed
    1. Brown WD, Burrows L, Todd CS. Ectopic pregnancy after cesarean hysterectomy. Obstet Gynecol. 2002;99(5 Pt 2):933–4. - PubMed
    1. Shao EX, Hopper K, McKnoulty M, et al. A systematic review of ectopic pregnancy after hysterectomy. Int J Gynaecol Obstet. 2018;141(2):159–65. - PubMed
    1. Anupama R, Beegum TR, Indu RN. Ruptured ectopic pregnancy 11 years after supracervical hysterectomy: a case report. Eur J Obstet Gynecol Reprod Biol. 2012;162(1):116–7. - PubMed