Chronic tubal ectopic pregnancy with a negative serum human chorionic gonadotropin test: A Case Report

Early measurements of β-hCG serum levels and Transvaginal ultrasound form the mainstay of timely ectopic pregnancy diagnosis. The current case highlighted, that an ectopic pregnancy may exist even in the setting of an undetectable initial β-hCG serum level and may go unnoticed if taken lightly. Difficulties in diagnosing chronic ectopic pregnancy make this clinical case a challenge in gynaecology and are not commonly reported in the literature. This case presents a 31 years old female patient, gravida5 para3, who attended the Emergency Department with a two-week history of spotting along with recent worsening associated with pelvic pain. On gynecological examination, blackish bleeding of endocavitary origin and adnexal tenderness especially on the right. Her β-hCG serum level was negative, checked twice in two different laboratories. An urgent transvaginal pelvic ultrasound showed a right heterogeneous tubal mass with a double component of 65 by 57mm. Laparoscopy revealed a heterogeneous ampulla mass of 4 cm related to an encysted hematocele in the right fallopian tube. The treatment consisted of a right salpingectomy. The final pathological analysis confirmed right tubal pregnancy. In the absence of typical clinical symptoms or characteristic ultrasound signs for this entity, a diagnostic laparoscopy is indicated and necessary to be carried out urgently, as presented in this case study, to prevent the complications of a ruptured pregnancy, thus decreasing a poor prognosis for the patient.