Ruptured Tubal Ectopic Pregnancy 7 Years After Subtotal Hysterectomy: A Rare Case Report

Pregnancy after subtotal hysterectomy is an exceptionally rare but potentially life-threatening condition that may delay diagnosis because pregnancy is often considered impossible. We report a 41-year-old (gravida 6, parity 6) woman who presented with sudden severe lower abdominal pain 7 years after emergency subtotal abdominal hysterectomy performed for postpartum hemorrhage secondary to uterine atony. Serum β-human chorionic gonadotropin was 2591 mIU/mL, and transvaginal ultrasonography demonstrated a ruptured right tubal ectopic pregnancy with an embryo corresponding to 6 weeks and 6 days of gestation. Exploratory laparotomy revealed approximately 300 mL hemoperitoneum and extensive pelvic adhesions. Right salpingo-oophorectomy together with excision of the cervical stump and remaining adnexa was performed. Histopathological examination confirmed tubal ectopic pregnancy. This case emphasizes that ectopic pregnancy should remain in the differential diagnosis of reproductive-aged women with preserved ovaries after subtotal hysterectomy, and that prompt β-hCG testing and transvaginal ultrasonography are essential for timely diagnosis and treatment.