Beyond the Usual: Diagnosing Ruptured Retroperitoneal Ectopic Pregnancy in a Patient With Negative Point-of-Care Ultrasound

Robinson Z, Queen J, Krizo J, Simon E, Simon EL
Journal of acute medicine · 2026 · doi:10.6705/j.jacme.202606_16(2).0007 · PMID:42238858 · PMC13227072
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This case report describes a successful diagnosis of a ruptured retroperitoneal ectopic pregnancy in a patient whose initial point-of-care ultrasound yielded negative results.

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This case report describes a 27-year-old female presenting with acute abdominal pain, tachycardia, and leukocytosis who was initially evaluated for appendicitis or ectopic pregnancy. Although point-of-care ultrasound was negative for intrauterine pregnancy and intraperitoneal fluid, further imaging identified a large pelvic mass, leading to surgical intervention. The patient was ultimately diagnosed with a ruptured retroperitoneal ectopic pregnancy requiring laparotomy and salpingo-oophorectomy, highlighting the diagnostic challenge of this rare condition when standard bedside imaging is inconclusive. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Ectopic pregnancy (EP) is a commonly seen, potentially life-threatening condition that can be challenging to diagnose in the emergency department (ED) setting. A retroperitoneal EP is an extremely rare condition, with a limited number of reported cases. Because of this, many emergency medicine physicians may not be familiar with presenting symptoms of a retroperitoneal EP. Rupture of an EP is a life-threatening complication that must be diagnosed quickly to reduce the risk of mortality. We present a 27-year-old female who presented with a two-day history of progressive right lower quadrant abdominal pain, nausea, and vomiting. ED evaluation revealed tachycardia of 140 beats per minute, and laboratory assessment was positive for leukocytosis of 27,030 k/uL and a positive qualitative human chorionic gonadotropin. The initial concern was for appendicitis versus ruptured ectopic pregnancy. Point-of-care ultrasound was negative for both intrauterine pregnancy and intraperitoneal fluid. However, there were heterogeneous contents within the pelvis of unclear etiology. Obstetrics was consulted, admitted the patient, and obtained a formal abdominal ultrasound to evaluate her appendix. The radiologist reported a 12 cm pelvic mass for which the differential diagnosis included a uterine fibroid, ectopic pregnancy, or appendicitis. The patient was taken to the operating room for a diagnostic laparoscopy and laparotomy and was diagnosed with a ruptured retroperitoneal EP. She underwent evacuation of the retroperitoneal hematoma and right salpingo-oophorectomy. She was discharged home on postoperative day four.
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- 期刊 - OpenAccess Ectopic pregnancy (EP) is a commonly seen, potentially life-threatening condition that can be challenging to diagnose in the emergency department (ED) setting. A retroperitoneal EP is an extremely rare condition, with a limited number of reported cases. Because of this, many emergency medicine physicians may not be familiar with presenting symptoms of a retroperitoneal EP. Rupture of an EP is a life-threatening complication that must be diagnosed quickly to reduce the risk of mortality. We present a 27-year-old female who presented with a two-day history of progressive right lower quadrant abdominal pain, nausea, and vomiting. ED evaluation revealed tachycardia of 140 beats per minute, and laboratory assessment was positive for leukocytosis of 27,030 k/uL and a positive qualitative human chorionic gonadotropin. The initial concern was for appendicitis versus ruptured ectopic pregnancy. Point-of-care ultrasound was negative for both intrauterine pregnancy and intraperitoneal fluid. However, there were heterogeneous contents within the pelvis of unclear etiology. Obstetrics was consulted, admitted the patient, and obtained a formal abdominal ultrasound to evaluate her appendix. The radiologist reported a 12 cm pelvic mass for which the differential diagnosis included a uterine fibroid, ectopic pregnancy, or appendicitis. The patient was taken to the operating room for a diagnostic laparoscopy and laparotomy and was diagnosed with a ruptured retroperitoneal EP. She underwent evacuation of the retroperitoneal hematoma and right salpingo-oophorectomy. She was discharged home on postoperative day four.

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