Tubal ectopic pregnancy-cause of acute abdomen following hysterectomy

Case report We report a case of ectopic tubal pregnancy long after hysterectomy who presented with an acute abdomen and collapse. Awareness of this condition will lead to early appropriate surgical intervention, as diagnosis is easily made in the accident and emergency department from the symptoms and/or simple pregnancy test. A 32-year-old woman was admitted with acute onset abdominal pain, vomiting and collapse. She was in hypotensive shock, blood pressure was 70 mmHg. There was mild abdominal distension, lower abdominal tenderness but no evidence of acute peritonitis. Two-and-a-ha lf years earlier, she had had a laparoscopic-assisted vaginal hysterectomy for endometriosis. Post-operatively, she developed an haematoma, which was drained at laparoscopy. While being resuscitated, an urgent ultrasound revealed free pelvic uid. At laparotomy, 3 litres of altered blood and a ruptured right tubal pregnancy were found. Right salpingectomy and histology con® rmed the diagnosis.