A rare case of a ruptured ovarian pregnancy

Abstract

Ovarian pregnancy is a rare type of extrauterine pregnancy accounting for 1 to 3% of all extrauterine pregnancies. We report a rare case of a ruptured ovarian pregnancy. A 22 year old, gravida 2 para 1 living 1 was admitted with amenorrhea of 4 weeks and 6 days with chief complaints of severe acute lower abdomen pain. Urine beta hCG pregnancy test was positive. Ultrasonogram of pelvis revealed left sided ruptured adnexal mass with moderated hemoperitoneum. Laparotomy was performed and a diagnosis of ruptured ovarian pregnancy was made. The mass was excised and sent for histopathological examination which confirmed the diagnosis. Although ovarian pregnancy is rare, in any case of a ruptured ectopic pregnancy where the tubes are found to be normal on laparotomy, an ovarian pregnancy must be ruled out. Early detection and prompt diagnosis can preserve the future fertility of the woman.

Primary Ovarian Ectopic Pregnancy: A Case Report

“…The presented case fulfilled the von Spiegelberg criteria for primary ovarian ectopic pregnancy based on the following histopathological findings: The gestational sac in the area of the ovary, ovarian tissue in the wall of the gestational sac, and intact associated ipsilateral fallopian tube (5); similar to the studies by Ghasemi et al (1), Bhuria et al (2), and Manjula et al (8). Although, the current case results were similar to those of the other studies, for more complete epidemiological information and comparison between the findings in a geographic region, case series studies are mandatory.…”

“…Ovarian ectopic pregnancy is a life threatening medical concept and its early detection is perhaps the most difficult, compared to all the other forms of extra uterine pregnancies and almost always, the primary diagnosis is made on the operating bed (8).…”

“…The ovarian pregnancy forms under 2 circumstances: First, when fertilization occurs in the peritoneal cavity and, then, fertilized ovum is implanted into the ovary; and second, when fertilization occurs in the fallopian tube and, then, via tubal abortion or perforation, products of conception are implanted on the ovarian surface (8).…”

“…The main risk factors of the development of primary ovarian ectopic pregnancy are as follows: Obstructed ovulation, malfunction of fallopian tube from previous salpingitis, endometriosis, application of intrauterine contraceptive devices, chronic pelvic inflammatory disease, Tuberculosis (especially in the developing countries), and assisted reproductive technology (in vitro fertilization and in vivo transfer of the embryo to the uterus (IVF-ET) and intrauterine insemination) (8,11,12). There were no evidence of such predisposing conditions and factors in the past medical history of the current case.…”

“…In the current case, based on the surgeon's decision, extension of lesion, and tissue destruction, right salpingo-oophorectomy was selected as the choice therapy. However, ovarian ectopic pregnancy has good prognosis; therefore, early diagnosis and immediate therapy can permit for conservative surgery and retain the future fertility of the patient (8).…”