Case Report: Ruptured Ectopic Pregnancy Originating from Pedunculated Leiomyoma

Introduction Ectopic pregnancy, defined as any pregnancy occurring outside of the uterine cavity, accounts for approximately two percent of pregnancies. The most common site of an ectopic pregnancy is the fallopian tube, with over 90% of cases being found in this anatomical region. We describe a rare case of an abdominal ectopic pregnancy implanted on a pedunculated subserosal uterine fibroid. On review of the current literature, there has been only one existing case report of this finding. Our case is unique in that the previous case report describes an IVF assisted pregnancy, while our patient had a spontaneous pregnancy with no ectopic risk factors and no prior uterine surgeries. Case Report A 30-year-old female, gravida 2, para 1 (vaginal birth), with no significant medical history presented to the emergency department at approximately 4 weeks gestation after sudden onset of sharp stabbing midline and left lower quadrant abdominal pain. Transabdominal and transvaginal ultrasound revealed a non-specific heterogenous, nonvascular mass of the right adnexa with no pelvic free fluid noted. The patient was taken urgently to the operating room for diagnostic laparoscopy. Upon entry into the abdomen, a ruptured ectopic pregnancy was identified at the inferior pole of a 4 cm pedunculated fibroid arising from the posterior fundal surface of the uterus with active bleeding. Discussion We describe the first case of an abdominal ectopic pregnancy implanted on a pedunculated subserosal uterine fibroid in a natural pregnancy. Our case serves as an important example of an abdominal ectopic that is not associated with IVF or other ectopic risk factors. Ultimately, gynecological surgeons must have a high index of suspicion for these atypical presentations and be ready to adjust to the surgical findings as they present.