2018 Volume 70 Issue 2 Pages 105-112
Ectopic pregnancy demonstrates typical symptoms and laboratory and image findings; however, they overlap with the symptoms of intrauterine pregnancy. Particularly, it is not always easy to diagnose the site of ectopic pregnancy rupture. Sometimes, confirmed diagnosis is not achieved using serum human chorionic gonadotropin (hCG), ultrasound, or magnetic resonance imaging (MRI). We identified the site of continuous intraperitoneal bleeding from a ruptured fallopian tube using dynamic computed tomography (CT) and performed emergency laparoscopic tubal resection. A 34-year-old female who had given birth twice visited an emergency outpatient department with the chief complaint of left lower abdominal pain. Little fresh blood was observed upon vaginal examination. Serum hCG level was 1667 mIU/ml. Her last menstruation occurred six weeks ago. Vaginal ultrasound confirmed ascites in Douglas fossa, but no genital sac in the uterus. Pelvic MRI confirmed ascites in Douglas fossa and around the bladder. We could not find a gestational sac using ultrasound or MRI. We suspected ectopic pregnancy; however, the serum hCG level was not very high, intraperitoneal bleeding was minor, and severe anemia was not observed; hence, conservative treatment was considered. Given that the gestational sac was not confirmed in the uterus despite the serum hCG level being 1500 mIU/ml or greater, the possibility of normal pregnancy was considered extremely low, and dynamic CT was performed as one of the diagnostic modalities. Intraperitoneal bleeding spread under the left diaphragm, and a linear contrast effect was observed at the ventral side of the left ovary. Because heavy bleeding was expected, emergency laparoscopic tubal resection was performed using Cell Saver 5Ⓡ. Autologous blood was returned (215g), and allogeneic blood transfusion was unnecessary. Hence, dynamic CT maybe useful when ultrasound or MRI cannot confirm a bleeding point. [Adv Obstet Gynecol, 70 (2) : 105-112, 2018 (H30.5)]
