Ectopic gestation in a tubal stump.

Case report The patient was a 30-year-old single negress who had had two previous normal confinements in 1952 and 1953. She was admitted to the Central Middlesex Hospital on 4 January 1966 complaining of an increasing generalized lower abdominal pain of 12 hr duration, nausea and shoulder pain. An episode of similar abdominal pain lasting 1 day occurred 8 days prior to her admission. Vaginal bleeding interpreted as a period occured on 24 December 1965 and lasted 7 days. There was no vaginal bleeding on admission. Menstruation had started at the age of 11 and the periods were regular, occurring every 28 days and lasting 7 days. Her last normal menstrual period was on 2 November 1965. Inquiry into the past medical history revealed that an appendicectomy was performed in 1958. A second abdominal operation, during which a cyst was removed, was done in 1959 in Dominica. On examination the patient looked ill. The mucous membranes were pale. Her pulse was weak, 104/min., temperature 98°F, BP 110/80 mmHg. Cardiovascular and respiratory systems were normal. The abdomen was distended in the suprapubic area and acutely tender, particularly in both iliac fossae. There was also a marked rebound tenderness. The bladder was distended and contained 500 ml of clear urine. There was no vaginal bleeding. The cervix was firmly closed but very tender to touch. The uterus could not be outlined because of marked pelvic tenderness. Both adnexae were very tender and there was fullness in the pouch of Douglas. Hb 53 % (7-7 g/100 ml). WBC 6300/mm3. ESR 11 mm/hr, blood group 0, rhesus-positive. A catheter specimen of urine showed no sugar or albumen and there were no pathogens. A diagnosis of intraperitoneal bleeding due to a ruptured ectopic gestation was made, and laparotomy was performed. Operation. The peritoneal cavity contained 1100 ml of blood and blood clot. The right Fallopian tube and ovary were normal. The left Fallopian tube and ovary were absent. The uterus was slightly enlarged and contained a pedunculated fibroid, 2.0 cm in diameter, on its right anterior wall. There was active bleeding from the left uterine cornu. Closer examination showed that there was a 2.5 cm long tubal stump, a remnant of a previously performed salpingectomy, containing an ectopic pregnancy. The gravid stump was fibrosed at its distal end and was separated from the uterus by a definite narrowing, as illustrated in Fig. 1. The round ligament was on the medical aspect of the gravid swelling. The rupture occurred near the uterine wall.