Ectopic pregnancy ruptured with hypovolemic shock after tubal recanalization, a case report and literature review

Abstract

Introduction: Ectopic pregnancy is defined as the implantation of the blastocyst in a different site of the endometrial cavity. One of the possible causes, but not the most frequent, is a history of surgery at the level of the uterine tubes. This entity has a high rate of morbidity and mortality, so the diagnosis must be timely.

Objective: To describe the clinical case of a patient with a complicated ruptured ectopic pregnancy, which presents secondary to a history of tubal recanalization and to carry out an updated review of the bibliography.

Materials and methods: A descriptive, retrospective study was carried out by presenting a clinical case. Informed consent was previously obtained from the patient. Additionally, a systematic search for scientific information was carried out in available databases such as Pubmed Central, Redalyc, Scielo, ScienceDirect.

Results: Female patient, 35 years old, with a surgical history of Pomeroy-type tubal sterilization by laparotomy 6 years ago and subsequent left tubal recanalization 4 months ago. She came due to intense pain at the abdominal level of 7 hours of evolution, physical examination with signs of severe hypovolemic shock, scant transvaginal bleeding and moderate anemia in laboratory tests, with positive beta-hCG. The ultrasound reports a heterogeneous image at the level of the left adnexa and an image suggestive of free fluid. With this condition, a laparotomy was performed that required left salpingectomy, repair of the intestinal serosa due to incidental injury and admission to the intensive care unit due to hypovolemic shock, with a favorable recovery after 5 days.

Conclusions: An accurate and timely diagnosis of ruptured ectopic pregnancy should be made, based on history, clinical manifestations and complementary studies. The association with the history of tubal recanalization should guide health caregivers to have a high index of suspicion. Efforts should be made to avoid delays in management in order to avoid additional complications during its resolution, such as hypovolemic shock.