Missed diagnosis in first trimester with ruptured tubal ectopic pregnancy in second trimester: a case report.

INTRODUCTION AND

IMPORTANCE

A ruptured tubal ectopic pregnancy in the second trimester is a rare presentation. In a reproductive age group presenting with a history of amenorrhea, per vaginal bleeding, abdominal pain with an empty uterus should always be suspected for ectopic pregnancy. Herein, we report a case of a ruptured tubal ectopic pregnancy in the second trimester, which was diagnosed during laparotomy for a suspected ruptured bicornuate uterus.

CASE PRESENTATION: A 29-year-old, married, with past history of left salpingectomy, second presentation to a district hospital in Bhutan was referred twice for suspected ectopic pregnancy, misdiagnosed as pregnancy in a bicornuate uterus on ultrasonography initially.

CLINICAL DISCUSSION: During the second referral, an emergency laparotomy found a ruptured right tubal ampullary ectopic pregnancy at 13 weeks 4 days period of gestation, massive hemoperitoneum and bowel adhesion in the left adnexal region. She had an uneventful postoperative recovery.

CONCLUSION

Presentation of ectopic pregnancy in the late first trimester is rare and leads to increased maternal morbidity and mortality. While there are evidences of a bicornuate uterus with an intrauterine pregnancy being mistaken for an ectopic pregnancy, the reverse can also be true, as in our case.