Chronic Ectopic Pregnancy: A Case Report

Chronic ectopic pregnancy (CEP) is an under-recognised variant of ectopic pregnancy, characterised by low or absent serum beta human chorionic gonadotropin (β-hCG), a complex adnexal mass, and non-specific clinical symptoms and signs. We present a case of a woman in her 30s with progressive lower abdominal pain, an equivocal pregnancy test, and spontaneous vaginal bleeding. Transvaginal ultrasound demonstrated an inhomogeneous, avascular right adnexal mass on ultrasound, with associated haemoperitoneum. A diagnostic laparoscopy revealed a haemorrhagic ampullary mass and 300 mL of intraperitoneal blood. The right fallopian tube was excised, and histopathological examination confirmed CEP. This case highlights the complexity of obtaining a diagnosis of CEP, particularly when symptoms and investigations may mimic other pelvic pathologies. Laparoscopic salpingectomy remains the mainstay of treatment as it eliminates the risk of any persistent trophoblastic tissue. CEP should remain a differential diagnosis in any patient of reproductive age with pelvic pain or abnormal bleeding, irrespective of β-hCG levels, to avoid premature discharge and reduce delays in definitive management.