A 33 year old woman, para 2, presented to the emergency department with a report of vaginal bleeding and abdominal pain of several days’ duration. She had no history of pelvic inflammatory disease. Right adnexal tenderness was noted on physical examination. On screening, the serum β human chorionic gonadotropin level was 47,281 IU per liter, corresponding to an embryonic gestational age of six weeks.
Ultrasonography demonstrated free fluid in the peritoneum, an empty uterus, and a right adnexal mass containing a gestational sac and live embryo. During emergency laparoscopy, the surgeon viewed the right ovary, which contained an intact chorion, and a 2 cm embryo extruding from the right fallopian tube. A large hemoperitoneum was present, with active bleeding from the implantation site. The fallopian tube could not be salvaged. The surgery was performed without complication, and the patient’s recovery was uneventful. Tests for gonorrhea and chlamydia were negative. The final pathological findings were consistent with a ruptured first-trimester ectopic pregnancy secondary to chronic follicular salpingitis.