Unusual Abdominal Ectopic Pregnancy Implantation in the Vesicouterine Pouch: A Case Report

Background: Primary abdominal ectopic pregnancy is a very rare condition that occurs when the gestational sac is implanted directly into the abdominal peritoneum. In many cases it is difficult to have an exact diagnosis before explorative and therapeutic laparotomy or laparoscopic surgery and most of them are diagnosed during surgery. It can be a life threatening condition with high morbidity due to misdiagnosis or mismanagement. Cases Report: A 36 -year-old Iranian woman was admitted to Mahdieh hospital emergency department of shahid Beheshti medical science university (Tehran, Iran) with vaginal spotting and abdominal right lower quadrant pain with a background history of 6 weeks’ amenorrhea and a significant beta-human chorionic gonadotropin of 26660 IU/L. Subsequent transvaginal sonography revealed paraovarian fluid and 20×23 hyperheteroechoic right adnexal mass with peripheral vascularity indicating probable ectopic pregnancy. Following that, she underwent diagnostic and therapeutic laparotomy. It showed 400 cc blood and 50 cc clot in vesicouterine pouch that were suctioned. There was no evidence of right adnexal ectopic pregnancy however a resemblance of trophoblastic tissue was located on the wall of uterovesical pouch on the omentum. Conclusion: We conclude that emergency laparotomy or laparoscopic surgery should be done to prevent occurrence of uncontrollable bleeding. Also utilizing MRI can be beneficial for exact detection the site of ectopic pregnancy before surgery which can be useful for perioperative planning and management of this condition.