Ruptured Tubal Ectopic Pregnancy after 4-Years Interval of Bilateral Tubal Ligation: A Case Report

Background: Bilateral tubal ligation (BTL) is an effective permanent method of birth control. However, it still has less than 1% possibility of failure, and it is associated with the risk of ectopic pregnancy. Case Presentation: A 36-year-old woman at 8 weeks of gestation, gravida 6 para aterm 5, was admitted to the emergency room with active vaginal bleeding accompanied by acute severe pelvic pain. Trans-abdominal ultrasound showed an empty uterine cavity with a mixed echogenic mass in the left adnexa and hemoperitoneum. Emergency exploratory laparotomy was done, and rupture of the distal segment of the left fallopian tube containing an intact gestational sac was found. The conception was evacuated followed by left salphingo-oophorectomy and right salphingectomy. Discussion: Postpartum tubal sterilization is associated with an increased risk of incomplete luminal occlusion, potentially leading to abnormal tubal recanalization. This allows sperm to traverse the tract while preventing passage of the fertilized ovum, resulting in ectopic implantation, typically within the fallopian tube. As the tube cannot support embryonic development, progressive gestation often leads to tubal rupture. Conclusion: Although BTL has a success rate exceeding 99%, thorough preoperative counselling is essential to ensure patients are aware of the small but significant risk of failure, including the potential for ectopic pregnancy.