Kata Kunci

Abstrak

Introduction: Ectopic pregnancy (EP) occurs when a fertilized egg implants and develops outside the uterine cavity, with the fallopian tube—particularly the ampulla—being the most common site. Positive blood β-hCG levels can suggest an EP, even in the absence of ultrasound confirmation for intrauterine or extrauterine pregnancy. Case Presentation: We present a case of a 37-year-old woman who was referred from primary health care with a diagnosis of ileus. The patient reported abdominal pain, spotting, vomiting, and no bowel movements since the previous day. Her estimated gestational age was around seven weeks. She exhibited signs of shock, with physical examination showing slight abdominal distention, decreased bowel sounds, diffuse tenderness, mild muscular guarding, and hyperresonance. Vaginal examination did not reveal cervical dilation or portio swaying pain. Laboratory tests indicated anemia and leukocytosis with neutrophil predominance. A positive pregnancy test was obtained in the emergency department, as the primary health care facility had not performed a pregnancy test. Abdominal x-ray showed low-lying obstructive ileus and ascites in the pelvic cavity. Transabdominal ultrasound revealed free fluid in the rectouterine cavity. An emergency laparotomy was performed, revealing a rupture in the ampullary segment of the fallopian tube, necessitating a salpingectomy. Conclusion: Accurate and prompt diagnosis of ectopic pregnancy is crucial. For women of childbearing age presenting with acute abdominal symptoms and a known or unknown history of menstruation, a qualitative β-hCG test is strongly recommended. This test is valuable for diagnosing and screening for ectopic pregnancy, especially in health facilities with limited resources and budget constraints.