A Case of Rupture Ectopic Pregnancy Diagnosed 10 Days After Hospital Stay In A 22-Year-Old Girl Presented With Symptoms of Anemia Without Abdominal Pain and Amenorrhea: Lessons Learned

Abstract

A 22-year-old unmarried Myanmar girl presented with symptoms of anemia: fatigue, exertional dyspnea and fainting attack. There was no abdominal pain or amenorrhea. The hemodynamic status was stable except sinus tachycardia. Anemia was refractory to blood transfusion; thus, the differential diagnosis were autoimmune hemolytic anemia and occult blood loss. Blood film, bone marrow examination, Comb tests, Anti-nuclear antibody profile and PNH screen tests excluded autoimmune hemolytic anemia. Presence of fibrous strands in free fluids of abdominal cavity with normal uterus and ovary mislead the diagnosis of tuberculosis. Blood tap in ascitic fluid aspiration made all the answer- rupture ectopic pregnancy. The symptoms resolved after right salpingectomy and blood transfusion. The clerking on sexual exposure to Myanmar single is not acceptable in our culture; it is regarded as “social insult”. Atypical presentation and not asking sexual history caused delay in diagnosis; diagnosed 10 days after hospital stay. She recovered uneventfully.