title: Repeat acute abdomen and hemoperitoneum during the same pregnancy due to a ruptured ectopic treated by salpingostomy.
abstract: A leading cause of maternal mortality in the first trimester is hemorrhage due to a ruptured ectopic pregnancy. With the advent of tube salvage surgery, ectopic pregnancies can be removed while ensuring hemostasis and preserving the integrity of the fallopian tube. A major drawback of tube salvage surgery is the significant risk of persistent trophoblastic tissue being left behind. We report a case of a 30year old female who presented to the ED with acute abdomen and hemoperitoneum due to a ruptured ectopic pregnancy. She was treated with salpingostomy and the pathologic report confirmed removal of the ectopic pregnancy. After an initially uneventful post-operative recovery, she presented to the ED 27days later with signs of acute abdomen and hemoperitoneum. Surgical intervention confirmed a ruptured ectopic pregnancy in the same site as previous, and salpingectomy was performed, after which the patient recovered without complications. The increased risk of persistent trophoblastic tissue associated with tube salvage surgery can lead to subsequent reoperation for tubal rupture. Patients undergoing these procedures should be closely monitored in the following weeks and undergo serial β-hCG testing in order to confirm successful removal of the ectopic.
authors.affiliation: Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States. Electronic address: ccanelas2015@health.fau.edu.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Canelas
authors.affiliation: Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shih
authors.affiliation: Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Clayton
authors.affiliation: Department of Emergency Medicine, Somerset Medical Center, Somerset, NJ, United States.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Giroski
authors.affiliation: Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Alter
authors.affiliation: Bethesda Health, Boynton Beach, FL, United States.
authors.forename: Stacey
authors.initials: S
authors.lastname: Feinstein
authors.affiliation: Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Learman
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology*; D000328:Adult; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000000981:diagnostic imaging* / Q000601:surgery*; D058994:Salpingectomy; D012489:Salpingostomy / Q000009:adverse effects*; D014463:Ultrasonography
keywords: Persistent trophoblast; Ruptured ectopic pregnancy; Salpingostomy; Tube salvage surgery