Abstract
The early diagnosis and minimally invasive management of ectopic pregnancy are usually possible because of the development of highly sensitive urine pregnancy tests and ultrasonography. We herein report a rare case of chronic ectopic pregnancy which was difficult to diagnose before laparoscopic surgery due to a negative urine pregnancy test. A 21-year-old female (gravida 1, para 0) presented with right lower abdominal pain and irregular vaginal bleeding. A urine pregnancy test with a sensitivity of 25 IU/L was negative at triage. Since a 4 cm heterogeneous mass was identified on the right side of the uterus by transvaginal ultrasonography, a degenerative uterine myoma was diagnosed. Since the symptoms lasted another month without relief, MRI and CT were performed, but no definitive diagnosis was made. Thereafter, a laparoscopic examination revealed that the right fallopian tube was swollen to 4 cm in diameter, with extensive circumferential inflammatory adhesions. Another urine pregnancy test was performed during the operation because a tubal pregnancy was suspected, but it was negative. After laparoscopic right salpingectomy, the symptoms improved. Based on a histological examination of the surgical specimen showing degenerated villi and viable trophoblasts, chronic right tubal pregnancy was diagnosed. In conclusion, although a urine pregnancy test is useful and essential to rule out ectopic pregnancy in females of reproductive age presenting with abdominal symptoms, the possibility of chronic ectopic pregnancy should be considered even in cases with negative results. Laparoscopic surgery can be useful for diagnosis and treatment when a chronic ectopic pregnancy is suspected.
