A positive urine pregnancy test with haemoperitoneum: misdiagnosed postpartum choriocarcinoma with uterine rupture mimicking ruptured ectopic pregnancy

Shakti Yeoh; Soon-Leong Yong; Pak-Inn Teoh; Marcus Kang

doi:10.1515/hmbci-2021-0048

Article

A positive urine pregnancy test with haemoperitoneum: misdiagnosed postpartum choriocarcinoma with uterine rupture mimicking ruptured ectopic pregnancy

Shakti Yeoh , Soon-Leong Yong , Pak-Inn Teoh and Marcus Kang

Published/Copyright: December 2, 2021

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From the journal Hormone Molecular Biology and Clinical Investigation Volume 43 Issue 1

Abstract

Objectives

Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed.

Case presentation

We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma.

Conclusions

The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis.

Keywords: choriocarcinoma; ectopic pregnancy; haemoperitoneum; postpartum; uterine rupture

Corresponding author: Soon-Leong Yong, Department of Obstetrics and Gynaecology, Tengku Ampuan Afzan Hospital, Jalan Tanah Putih, 25100 Kuantan, Pahang, Malaysia, Phone: +6017 9197139, E-mail: yongsoonleong@yahoo.com

Acknowledgments

The authors would like to thank the Director of Health Malaysia for permission to publish this paper.

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from the patient.
Ethical approval: The conducted research is not related to either human or animals use. This case report had been registered to National Medical Research Register (under Ministry of Health Malaysia) and Institutional Review Board (IRB) approval was obtained. The Research Identification Number given was NMRR-18-1138-42069.

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Received: 2021-05-27

Accepted: 2021-11-21

Published Online: 2021-12-02

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Articles in the same Issue

https://doi.org/10.1515/hmbci-2021-0048

Keywords for this article

choriocarcinoma; ectopic pregnancy; haemoperitoneum; postpartum; uterine rupture