Abdominal ectopic pregnancy is a more complicated and severe situation, as compared with tubal pregnancy. Accurate differential diagnosis between abdominal and tubal pregnancy is important before the choice of laparoscopic approach. We presented the use of contrast-enhanced computed tomography (CT) to diagnose an unusual presentation of large tubal pregnancy mimicking abdominal pregnancy.
A 24-year-old woman presented to emergency room (ER) with acute abdominal pain. Transabdominal ultrasound demonstrated an empty uterus, a 6 cm crown-rump length (CRL) live fetus about 12 weeks of gestation of uncertain location, and massive hemoperitoneum. Due to the lack of high-resolution transvaginal ultrasound available in ER, the initial transabdominal ultrasound failed to clarify the extent of placental involvement. Contrast-enhanced CT scan revealed that placenta was located in the right adnexa, without omental and bowel and other peritoneal cavity seeding. Meanwhile, the blood supply of placenta was well visualized and located, without connection with surrounding tissue. Thereafter, we choose laparoscopic approach. During operation, we found an engorged ampulla on the right Fallopian tube with a live fetus inside, the internal blood loss was 3800 mL. Right salpingectomy was done; the surgical specimen was then removed via a mini-laparotomy. The patient recovered well and was discharged without any sequelae.
Contrast-enhanced CT scan is useful to offer an accurate differential diagnosis between abdominal and tubal pregnancy before the use of laparoscopic approach.