Abdominal ectopic pregnancy – misdiagnosed upper abdominal pain: A case report

RATIONALE: Ectopic pregnancy (EP) with implantation in the upper abdomen is exceptionally rare. It represents a challenging clinical scenario with very limited evidence confined to case reports. It seriously endangers maternal health and early diagnosis and treatment can significantly improve patient prognosis. PATIENT CONCERNS: We report a 25-year-old woman who was diagnosed several days ago with gastroenteritis was referred to our department because of worsened upper left abdominal pain. Contrast computerized tomography scan revealed a mass measuring ~46 mm × 40 mm × 56 mm in the upper left abdomen and her serum human chorionic gonadotropin level was 10,130.28 IU/L. EP was highly suspected on admission. DIAGNOSES: Abdominal EP was confirmed by intraoperative findings and postoperative pathology. INTERVENTIONS: The patient underwent laparoscopic surgery which went smoothly after admission. An gastrointestinal surgeon was involved during the surgery and the excision of the EP lesion along with partial omentum was performed. OUTCOMES: The patient was discharged 5 days later after operation without complications. The serum human chorionic gonadotropin level declined to normal within 1 month follow-up. LESSONS: This case illustrates that although ultrasound is considered the first-line method for diagnosing EP, abdominal lesions with undefined nature detected by computerized tomography should also be pay attention to, especially for women of childbearing age presenting with gastrointestinal symptoms other than typical ones such as lower abdominal pain or vaginal bleeding. Close monitoring and timely management are pivotal to improve patient prognosis.