A 33-year-old-woman presented to the gynaecological emergency department with pain under right curvature. There was no prior gynaecological morbidity except for an earlier induced abortion. The patient had menostasia for 6 weeks and 5 days and positive urinary human chorionic gonadotrophin (HCG); there was no vaginal discharge.
A transvaginal ultrasound (TVS) was performed and showed no intrauterine pregnancy. On the right side there was a process of 34 × 17 mm suspected as a corpus luteum and on the left side a normal ovary, and 53 × 20 mm free-fluid was seen in the recto-uterine-pouch. Blood samples showed normal haemoglobin and β-HCG of 918. The patient was clinically unaffected and the abdomen soft on palpitation.
The next day the β-HCG has fallen to 760, the patient was relatively unaffected and was discharged from hospital on suspicion of a tubarian spontaneous miscarriage. She was to be monitored by β-HCG.
After 3 days the β-HCG level had increased to 1270 and the patient was given methotrexate (MTX) on suspicion of early ectopic pregnancy.
However, a week after MTX the patient was readmitted to hospital due to pain under right curvature. β-HCG had fallen to 259, but the patient was severely affected by pain and the abdomen was no longer unaffected on palpitation with rebound tenderness.
A TVS was performed and showed no sign of ectopic pregnancy or intra-abdominal liquid. At laparoscopy, using standard laparoscopic equipment and instrumentation, a unicornuate uterus with a normal left fallopian tube and a normal left ovary was identified. The right ovary was found high on the right pelvic wall looking unusually long. There was no right fallopian tube outgoing from the uterus, but a structure resembling a fallopian tube was seen over the right flexure of colon transversus (–). Glued to this was a process, interpreted as an ectopic pregnancy of a non-communicating fallopian tube. In the abdomen, 100–200 ml blood was found. The patient had an unremarkable postoperative course.
Right ovary at the pelvic entrance.
Ectopic pregnancy by right curvature.
Ovary and salpinx with ectopic pregnancy near right curvature.