Tubal Stump Ectopic Pregnancy Following Salpingectomy: A Rare Diagnostic Challenge

A tubal stump ectopic pregnancy is a rare but serious complication following salpingectomy. This case report not only highlights the rarity of this event but also the potential diagnostic challenges involved. A 29-year-old woman with a history of ectopic pregnancy and prior left salpingectomy presented to the emergency department with abdominal pain and bleeding during early pregnancy. She reported bilateral lower abdominal pain, which had progressively worsened over two days. Her pregnancy had been recently confirmed, and her obstetrician-gynecologist (OBGYN) was monitoring her beta-human chorionic gonadotropin (HCG) levels. At the time of presentation to the emergency room, her beta-HCG levels had decreased compared to the levels recorded a week earlier. Ultrasound evaluation revealed a right ectopic pregnancy with possible hemoperitoneum. Laparoscopic evaluation subsequently identified the ectopic pregnancy in the left fallopian tube stump. The patient's hemoglobin level at presentation was 7.4 g/dL, necessitating a blood transfusion. The patient underwent successful surgical intervention and was discharged the following day. There is limited literature regarding tubal stump ectopic pregnancies, and no established guidelines exist to address their prevention. One case study has suggested a potential association between tubal stump length and the risk of future tubal stump ectopic pregnancy. Maintaining a high index of suspicion is critical in such cases, especially when clinical symptoms are non-specific and may mimic other gynecologic conditions. The patient's preservation of fertility is a testament to the success of early recognition and surgical intervention in such complex cases. The initial misinterpretation of ultrasound findings suggests the need for advanced imaging techniques to confirm the precise location of rare ectopic pregnancies. Further exploration of this area could help improve diagnostic accuracy and patient outcomes.