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Eleje GU, Udigwe GO, Njoku TK, Okoro CC, Onyejiaka CC, Ihekwoaba EC, Ndukwe CO, Anaedu OP, Chiemeka ME, Okafor CG, Ekwebene OC, Offor CC, Okoye OA, Okolie PC, Malachy DE, Maduagwu CI, Mmuotoo JRI, Nwankwo EU, Duru CO, Igbodike EP, Obiegbu NP, Agbo JC, Okeke NC, Ezenwafor OO, Nneji HC, Dimgba OO, Okonkwo JE. Challenges of Management of Ruptured Second Trimester Ovarian Pregnancy in Low-and Middle-Income Settings: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231153285. [PMID: 36798956 PMCID: PMC9926361 DOI: 10.1177/11795476231153285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
Background Ovarian ectopic pregnancy is a rare form of non-tubal ectopic pregnancy. It can rupture before the end of the first trimester, causing hemoperitoneum, and present with signs and symptoms similar to other commoner abdominal emergencies or the pregnancy can continue intraperitoneally. Therefore, they are not often diagnosed preoperatively. Ultrasound can assist in diagnosis of ovarian ectopic pregnancy but the findings could be ambiguous or inconclusive. We present a case of ruptured ovarian ectopic pregnancy at the second trimester causing massive hemoperitoneum that was suspected as an intrabdominal malignancy co-existing with intrabdominal pregnancy. Case presentation She was a 34 year-old Nigerian unbooked G4P3+0, (3 alive), who presented to the labor ward on 21st January, 2021 with a complaint of a 6-week history of abdominal pain and swelling. Pain was insidious in onset, generalized, non-colicky, non-radiating, constant, no known aggravating or relieving factor, but it was of moderate intensity. She had amenorrhea with a positive serum pregnancy test without prior early ultrasound. At presentation, initial abdominopelvic ultrasound revealed intra-uterine viable pregnancy but repeat ultrasound done showed a left adnexal ectopic gestation and an echo-rich intraperitoneal fluid collection. Laparotomy was done and ovarian pregnancy was accurately diagnosed intra-operatively. Tissue samples from the ovary confirmed normal products of conception, namely chorionic villi, trophoblastic cells and ovarian stroma at histology. Conclusion Despite advances in imaging techniques, the diagnosis of ovarian ectopic gestation is still very difficult. When premenopausal women present with amenorrhea, generalized non-colicky abdominal pain and swelling in combination with ambiguous findings of pregnancy on ultrasound in the absence of trauma, differential diagnoses should include ruptured ovarian pregnancy. Obstetricians should maintain a high index of suspicion to forestall delayed diagnosis and the potential maternal morbidity and mortality. However, the need for high-index of suspicion should be for any ectopic, not just ovarian pregnancy.
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Affiliation(s)
- George Uchenna Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria,George Uchenna Eleje, Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka (Nnewi Campus), P.M.B. 5001, Nnewi, Anambra State, Nigeria. Emails: ;
| | - Gerald Okanandu Udigwe
- Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria,Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Tobechi Kingsley Njoku
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | | | | | | | - Chinedu Onwuka Ndukwe
- Department of Anatomic Pathology and Forensic Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Onyedika Promise Anaedu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Michael Emeka Chiemeka
- Department of Anatomic Pathology and Forensic Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chigozie Geoffrey Okafor
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Onyeka Chukwudalu Ekwebene
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Confidence Chinaza Offor
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Odili Aloysius Okoye
- Department of Surgery, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Perpetua Chinedu Okolie
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | | | - Chimdindu Ifunanya Maduagwu
- Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Jane-Rita Ifeoma Mmuotoo
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ekeuda Uchenna Nwankwo
- Rural Community Clinical School, School of Medicine, Deakin University, Victoria, Australia
| | - Chimezuru Ogechi Duru
- Department of Family Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Emeka Philip Igbodike
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Nnaedozie Paul Obiegbu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Joy Chisom Agbo
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Nwabueze Chidozie Okeke
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ogonna Onyeka Ezenwafor
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Henry Chinedu Nneji
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ogechi Odinakachukwu Dimgba
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - James Egwuatu Okonkwo
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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