article · International Journal of Surgery Case Reports
This case report outlines the clinical and socio-cultural challenges of managing a recurrent ectopic pregnancy in a woman who previously underwent a unilateral salpingectomy. A 36-year-old patient presented at eight weeks of gestation with lower abdominal pain and pelvic fluid, resulting in a left salpingectomy for a ruptured ectopic pregnancy. A prior ectopic pregnancy increases the risk of recurrence, and radical surgical intervention risks absolute infertility. In settings where cultural norms place high value on childbirth, fertility loss leads to stigma. Furthermore, advanced reproductive technologies like in vitro fertilisation and embryo freezing remain expensive or inaccessible in low-resource environments. The case highlights the conflict between patient autonomy regarding fertility preservation and the clinical need to prevent life-threatening maternal complications, underscoring the necessity of informed consent, counselling, and psychological support.
Managing ruptured ectopic pregnancies becomes acutely difficult when life-saving surgery eliminates any natural chance of future conception. In low-resource areas where assisted reproduction is unavailable or unaffordable, fertility loss can cause severe social and psychological harm. This highlights the vital need for empathetic clinical care that pairs emergency surgical intervention with comprehensive counselling, ethical decision-making, and psychological support.
The abstract does not indicate an application pathway or commercialisation opportunity, as it documents a single clinical case report and discussion of treatment dilemmas.
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INTRODUCTION: An ectopic pregnancy (EP) occurs when the blastocyst implants outside the endometrial lining of the uterine cavity. The loss of fertility poses a dilemma in the radical treatment of ruptured ectopic pregnancy. This case report is presented in line with the SCARE criteria. CASE PRESENTATION: A 36-year-old woman, G3P1 + 1 L1, at 8 weeks of gestation, presented with lower abdominal pain that was localized in the left iliac region. The pain was not associated with per vaginal spotting or bleeding. Pelvic ultrasonography revealed a significant fluid collection in the pouch of Douglas. A left salpingectomy was performed. DISCUSSION: A history of one ectopic pregnancy increases the risk of a subsequent EP by approximately 10 %, while having more than one previous ectopic pregnancy raises the risk to around 25 %. In communities where reproduction is believed to be an essence of womanhood, the loss of fertility carries serious socio-cultural consequences. These include not only external stigma but also internalized self-stigma that presents a significant dilemma when considering definitive treatment for a recurrent contralateral ruptured EP in a patient with a prior salpingectomy, particularly in low-resource settings, where IVF-ET and egg/embryo freezing are costly or unavailable. Surgical management of recurrent EP does not significantly impact the outcomes of IVF-ET. CONCLUSION: A patient who refuses salpingectomy after a recurrent ruptured EP faces a dilemma between preserving autonomy and preventing potentially life-threatening complications. A comprehensive approach should include discussions about alternative fertility options, patient education, psychological support, and ensuring that all decisions are fully informed.
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DOI: 10.1016/j.ijscr.2025.111507
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