A Rare Case of an Ectopic Pregnancy in the Pouch of Douglas and a Review of Abdominal Ectopic Pregnancies

Abstract

Introduction: It is predicted that the prevalence of abdominal ectopic pregnancy ranges between 1:10,000 to 1:30,000 pregnancies. Maternally mortality is high, at an estimated 5-18%. In this report, we detail a case of an ectopic pregnancy implanted in the pouch of Douglas secondary to tubal abortion. Case Report: A 29 year old pregnant female presented to Accident & Emergency with a 12 hour history of severe, constant right iliac fossa pain and vaginal bleeding. Patient had severe tenderness in the right adnexa. Her beta human chorionic gonadotropin serum level was 31,382 IU/L. Ultrasound scan revealed a mass next to the uterus. A provisional diagnosis of an ectopic pregnancy was made. Ovarian malignancy and gestational trophoblastic disease were also considered. Diagnostic laparoscopy revealed large complex mass in the pouch of Douglas which was removed. She recovered well following the surgery. Conclusion: Ultrasound remains the gold standard for investigating an ectopic pregnancy or to rule out other differentials that can clinically present in the same manner. However, as only 50% accuracy can be assumed when diagnosing an early abdominal ectopic with ultrasound, a high index of suspicion is required. A diagnostic laparoscopy is invaluable in diagnosis and management of an ectopic pregnancy.