A case report of secondary ectopic pregnancy on the hepatic diaphragmatic surface originating from tubal abortion detected by the second laparoscopy after primary salpingectomy.

RATIONALE

Ectopic pregnancies tend to occur in the fallopian tubes. Secondary abdominal pregnancies (SAP) are much rarer. Laparoscopic salpingectomy is a commonly performed radical surgery. However, even if a patient has undergone radical surgery, we cannot take it lightly.

PATIENT CONCERNS

We report a relatively rare case here: an SAP on the hepatic diaphragmatic surface originating from a tubal abortion detected by a 2nd laparoscopy after primary salpingectomy. The patient was admitted to the local hospital for "ectopic pregnancy" half a month ago and underwent laparoscopic left salpingectomy and right tubal ligation 45 days later. But her values of beta-human chorionic gonadotropin (β-hCG) continued to rise and she experienced pain in the right shoulder, right subclavian, and right lower abdominal (Murphy sign) after the 1st surgery.

DIAGNOSES

The final diagnosis was secondary ectopic pregnancy at the hepatic phrenic surface.

INTERVENTIONS

Half a month after the 1st operation, the patient underwent a laparoscopic examination in our hospital.

OUTCOMES

After the 2nd operation, her β-hCG value decreased to normal and menstruation resumed.

LESSONS

In the face of ectopic pregnancy, we need to continue to monitor the β-hCG value. SAP may occur even if it is relatively rare. Pay attention to the collection of symptoms and signs of patients to reduce missed diagnoses. It is vital for physicians to control the timing of surgery. Sometimes, it is necessary to emphasize the importance of comprehensive exploration and rapid pathological examination during the operation.