Two Consecutive Ruptured Tubal Ectopic Pregnancies after Interval Bilateral Tubal Ligation

Abstract

Background

Bilateral tubal ligation (BTL) is an effective permanent method of birth control that is surgically performed to block the woman’s fallopian tube and prevent the egg from meeting the sperm. It is preferred by women or couples who have achieved their reproductive potential and do not desire pregnancy. BTL carries a low risk of method failure with a subsequent pregnancy which is likely to be ectopic. We present a case of two consecutive ruptured tubal ectopic pregnancies following an interval BTL.

Case Presentation

A 40-year-old female, with 7 living children, who previously underwent an interval BTL, presented with acute abdominal pain for 2 days and amenorrhea for 6 weeks. She was stable but had generalized abdominal tenderness, guarding and rebound tenderness, and cervical motion tenderness. Her urine HCG was positive, and a trans-abdominal ultrasound scan revealed a tender echo-complex right adnexal mass, free fluid in the Cul-de-sac, and an empty uterine cavity, consistent with a ruptured right ectopic pregnancy. An emergency exploratory laparotomy was done with findings of a ruptured right distal tube containing products of conception, hemoperitoneum, and previous tubal ligation and left salpingectomy. A right total salpingectomy was done, and the excised right tube containing the mass was sent for histological examination, which revealed chorionic villi and hemorrhagic vascular decidual tissue in the fallopian tube, features suggestive of tubal ectopic pregnancy.

Keywords:

• ruptured
• tubal
• ectopic
• pregnancy
• interval
• bilateral tubal ligation

Data Sharing Statement

The information used and/or analyzed during the case are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

No institutional approval was required to publish this case, as this case was identified during routine clinical care. The patient provided an informed written consent.

Consent for Publication

The patient provided an informed written consent for this case and images to be published in a peer-reviewed journal.

Acknowledgments

We acknowledge the emergency care staff and theater staff. The abstract of this paper was presented at the “Sexual and Reproductive Health: Informing Policy and Practice through Research and Preservice Training” The Centre for International Reproductive Health Training at the University of Michigan conference in Kigali 2022, as a poster presentation/conference talk with interim findings. The abstract of this paper (074 – Two consecutive ruptured tubal ectopic pregnancies after interval bilateral tubal ligation: a case report) was published in “Poster Abstracts” in CIRHT The Centre for International Reproductive Health Training at the University of Michigan: https://cirht.med.umich.edu/abstracts-2/

Author Contributions

Moses Owiny contributed to the work reported, in the conception, study design, execution, acquisition of data, analysis and interpretation as well as drafting, revising or critically reviewing the article. Oliver Akello Anyeko, Monica Acen Okwir and Joram Okeng contributed to data acquisition, execution, analysis and interpretation, manuscript writing and reviewing the article. All the authors gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for the work.

Disclosure

The authors do not have any conflicting interests to declare for this work.

Additional information

Funding

There was no funding for this work.