Acute Hemoperitoneum Secondary to Chronic Hematosalpinx: A Diagnostic Challenge in the Setting of a Negative Pregnancy Test

Acute hemoperitoneum represents a gynecological and surgical emergency with significant morbidity if diagnosis and intervention are delayed. In women of reproductive age, the etiology is most frequently ruptured ectopic pregnancy; however, when pregnancy testing is negative, the differential diagnosis becomes considerably broader and less well defined. Hematosalpinx, although most commonly associated with ectopic gestations, may also occur secondary to non-pregnancy-related etiologies, including endometriosis, pelvic inflammatory disease, or primary tubal pathology. In rare instances, chronic hematosalpinx can rupture or leak, leading to substantial intraperitoneal hemorrhage and clinical features that mimic more common acute abdominal emergencies. This diagnostic uncertainty may obscure timely recognition and delay appropriate management. This case demonstrates acute hemoperitoneum secondary to chronic hematosalpinx in the context of a negative pregnancy test and highlights the diagnostic challenge. Pelvic and transvaginal ultrasound usually represents the first-line imaging modality for suspected adnexal pathology, aiding differentiation between hematosalpinx and ruptured ectopic pregnancy before proceeding to CT or surgical exploration. Early recognition and prompt surgical intervention are essential for accurate diagnosis, definitive treatment, and preservation of reproductive potential.