Trojan horse in obstetric complications: A case report of concurrent uterine perforation, incarcerated fallopian tube and cesarean section scar pregnancy.

RATIONALE: Uterine perforation complicated by incarcerated fallopian tube and cesarean scar pregnancy (CSP) constitutes an exceptionally rare and clinically challenging condition. The diagnostic dilemma arises from elevated β-hCG levels combined with parauterine mass formation, which frequently mimics tubal ectopic pregnancy presentation. This case report aims to highlight the critical importance of differential diagnosis in preventing clinical mismanagement of this complex obstetric emergency.

PATIENT CONCERNS: A 35-year-old woman (gravida 3, para 2) with recent Dilation and Curettage (D&C) presented with abdominal pain, vaginal bleeding, and elevated β-hCG, initially misdiagnosed as tubal ectopic pregnancy.

DIAGNOSES: Initial transvaginal ultrasound detected a right adnexal mass with intrauterine fluid. Magnetic resonance imaging demonstrated communication between the mass and uterine myometrium. Repeat transvaginal ultrasound confirmed CSP, surgically validated.

INTERVENTIONS: Combined laparoscopic-hysteroscopic surgery performed uterine perforation repair, CSP resection, and right fallopian tube repositioning.

OUTCOMES: The patient was discharged on postoperative day 7 without complications.

LESSONS: Heuristic-driven cognitive bias significantly contributes to diagnostic error. For multiparous women following abortion, heightened vigilance is essential to guard against the occurrence of this rare condition.