Faisal G Bhopal, Adeela Tazeem, Fareena Azim, Tasneem Akhter, Aslam Rai.
Primary Extra Peritoneal Pregnancy.
J Rawal Med Coll Jan ;6(2):77-9.

A 25-year old lady, gravida 4, para 3, from a rural area of Abbottabad, was admitted to the emergency room of a private hospital in Rawalpindi. She gave a history of severe pain in right half of lower abdomen for three days, the last menstrual period having occurred 8 weeks previously. Her menstrual periods were irregular since menarche, with a cycle length of 12 days, almost twice a month. Four days prior to admission, she experienced severe right sided abdominal pain and went to a Dai of the area. She received an intravenous injection and four tablets orally. Also a piece of cotton soaked in some medicine was placed in her vagina. Afterwards the severe pain that had been in the worst form, initially in the lower abdomen, spread to whole right half of abdomen. There was associated constipation for three days. On examination, the patient was pale and in shock. Her pulse was 130 per minute, low volume and blood pressure 100/70 mmHg. Abdominal examination revealed generalized tenderness and marked peritoneal irritation in the right iliac fossa, right lumbar region and right inguinal region. The abdomen was distended, with rebound tenderness and guarding. Pelvic examination showed anteverted and bulky uterus (size unremarkable due to tenderness) and clear adenxae. The pregnancy test was positive. Her hemoglobin value was 8.4g/ dl. Urinary albumin was ++ with a trace of bilirubin and bile salts. Abdominal ultrasonography showed extensive amount of free fluid in the peritoneal cavity. Uterus was empty and no mass present in the adenxal region. A diagnosis of ruptured ectopic pregnancy was made, intravenous therapy was started, preparations were made and the attending surgeon called for an emergency laparotomy. At laparotomy, upon entering the abdomen via a midline incision, pus was found in the generalized peritoneal cavity. A gangrenous patch of peritoneal and extra peritoneal tissues was noted. Black clotted blood and an embryo of approximately 8 weeks gestation was found after dividing the parietal peritoneum along anterior abdominal wall at the right deep inguinal ring upwards and laterally. Complete skeleton of the foetus was delivered from this pocket between peritoneum and anterior abdominal muscles.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com