Blood clot, the innocent culprit of pain in hypochondrium: an unusual presentation of ectopic pregnancy

Abstract

Chronic ectopic pregnancy is a variant of ectopic pregnancy presenting as chronic lower abdominal pain, menstrual irregularity and pelvic mass. Often, chronic ectopic may pose diagnostic conundrum due to unusual presentations. We are presenting an unusual case of chronic ectopic with negative urine pregnancy test, who presented with pain in right hypochondrium. The patient had bilateral adnexal mass with omental deposit on imaging masquerading adnexal malignancy, leading to decision for surgical management. Intraoperatively blood clots were present in supramesocolic compartment along with bilateral adnexal masses. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with clots evacuation was done and postoperatively, patient had complete relief of her symptoms. Final histopathology came out as ectopic gestation. Culminating point is to keep ectopic pregnancy as differential in all reproductive age group women presenting with pain in abdomen regardless of other symptom particularly with pelvic mass.