Missed diagnosis in first trimester with ruptured tubal ectopic pregnancy in second trimester: a case report

Introduction and importance: A ruptured tubal ectopic pregnancy in the second trimester is a rare presentation. In a reproductive age group presenting with a history of amenorrhea, per vaginal bleeding, abdominal pain with an empty uterus should always be suspected for ectopic pregnancy. Herein, we report a case of a ruptured tubal ectopic pregnancy in the second trimester, which was diagnosed during laparotomy for a suspected ruptured bicornuate uterus. Case presentation: A 29-year-old, married, with past history of left salpingectomy, second presentation to a district hospital in Bhutan was referred twice for suspected ectopic pregnancy, misdiagnosed as pregnancy in a bicornuate uterus on ultrasonography initially. Clinical discussion: During the second referral, an emergency laparotomy found a ruptured right tubal ampullary ectopic pregnancy at 13 weeks 4 days period of gestation, massive hemoperitoneum and bowel adhesion in the left adnexal region. She had an uneventful postoperative recovery. Conclusion: Presentation of ectopic pregnancy in the late first trimester is rare and leads to increased maternal morbidity and mortality. While there are evidences of a bicornuate uterus with an intrauterine pregnancy being mistaken for an ectopic pregnancy, the reverse can also be true, as in our case.