Thrilling case of ectopic pregnancy almost misdiagnosed as cirrhosis and ascites

Ms. Khuc Thi Ken, 31 years old, Tan Yen district, Bac Giang province, only breathed a sigh of relief today, after surgery by doctors at Bac Giang Obstetrics and Pediatrics Hospital. Ms. Ken has a complicated medical condition. She went to many medical facilities but found it difficult to find the exact illness.

According to the doctor at Bac Giang Obstetrics and Children’s Hospital, Ms. Ken has cirrhosis and hypothyroidism. The symptoms of ectopic pregnancy are not typical, so correctly diagnosing the disease to have appropriate treatment is not easy.

Intrauterine or ectopic pregnancy?
Ken’s “journey” to Bac Giang Obstetrics and Pediatrics Hospital was a long process. When she arrived at the hospital, she was tired, had pale skin, and had abdominal pain.

Ms. Ken recounted that recently, sometimes I have stomach pain, and after taking painkillers it helps for a few days, then the pain returns.

Went for a check-up at a medical facility near my home. The doctor diagnosed me with cirrhosis and ascites and prescribed medication to take. However, my condition did not improve, my stomach hurt more, so I went to Hanoi for a check-up.

There I had blood tests, an ultrasound, and a bone marrow aspiration to do a myelogram. The doctor made an appointment with me 2 days later and will announce the exact results.

When I got home and waited for the results, my stomach continued to hurt and I was dizzy. This month I missed my period again so my family took me to Bac Giang Obstetrics and Pediatrics Hospital.

Arriving at Bac Giang Obstetrics and Children’s Hospital, patient Khuc Thi Ken was examined by the doctor, ordered to do the necessary tests and referred to the results of patients examined in Hanoi, and found to have some main symptoms as follows:

  • Patients with fatigue, pale skin and mucous membranes, abdominal pain, and a history of anemia of unknown cause requiring a blood transfusion.
  • The patient’s ultrasound results at a hospital outside Hanoi and other hospitals were cirrhosis of the liver and ascites, with no pregnancy in the uterus.
  • Patient has anemia: red blood cell count 2.68T/L; hemoglobin Hb 84g/L;
  • Ms. Ken has a beta HCG test result of 105 IU/L.

With the above symptoms, doctors all pointed to patient Khuc Thi Ken’s condition as cirrhosis of the liver, free fluid in the abdomen as ascites due to cirrhosis and the patient’s anemia as chronic anemia. can result from cirrhosis or blood disease (this is the reason why the hospital in Hanoi gave the patient a bone marrow test).

The concentration of beta HCG in the blood is very low, only 105 IU/L (standard for diagnosing ectopic pregnancy is > 1,000 IU/L combined with ultrasound showing no pregnancy in the uterine cavity), making doctors think of a situation. is a patient who has recently become pregnant or has regressed pregnancy.

It is for these reasons that the doctors of the Department of Obstetrics and Gynecology – Bac Giang Obstetrics and Pediatrics Hospital are very confused about whether to transfer the patient to a higher level hospital to treat cirrhosis and monitor the patient’s pregnancy status or keep the patient. Stay in the hospital to continue monitoring the patient’s pregnancy until it is clearly determined whether the pregnancy is internal or ectopic.

And to provide appropriate treatment for patient Khuc Thi Ken’s condition, the doctor of the Department of Obstetrics and Gynecology invited CKII Le Cong Tuoc, Director of the Hospital, to chair the consultation and make the final decision.

“In Ms. Ken’s case, it was not easy to correctly diagnose the pathology” – Doctor Le Cong Tuoc said.

Careful clinical and laboratory analysis to find the “knot”

After examining, asking questions, analyzing data and test results, Doctor Le Cong Tuoc discovered the key points to diagnose and confirm that patient Khuc Thi Ken had an ectopic pregnancy, not fibroids. Liver ascites due to the following reasons:

Clinically, the patient does not have collateral circulation (an enlarged blood vessel under the skin of the abdomen due to cirrhosis that causes loss of central lobule veins, increasing portal vein pressure and blood will follow the portal-aortic connection through venous system under the abdominal skin).

Furthermore, the biochemical test result of Albumin/Globulin ratio >1 can rule out that this is ascites due to cirrhosis (although the ultrasound image shows typical cirrhosis).

Regarding analysis of blood test results: patient with isochromic anemia (red blood cell count HC 2.68T/L; hemoglobin Hb 84g/L; average red blood cell volume MCV 94.8 fl; blood volume average red blood cell pigment MCH 31.3 pg) and a blood test from a medical facility in Hanoi showed an increased percentage of reticulocytes, so this is anemia due to blood loss.

Thus, through clinical analysis and test results, it can be confirmed that the free fluid in the abdomen is blood and the cause is the patient’s ectopic pregnancy (Beta HCG 105 IU/L).

Accurately analyzing test results to make the correct diagnosis of the disease and deciding on laparoscopic surgery for ectopic pregnancy is of great significance to the patient’s life because if the disease is misdiagnosed and medical treatment for fibroids is liver ascites, the patient will continue to bleed in the abdomen and die from blood loss.

Management of ectopic pregnancy is complicated
It is known that laparoscopic surgery for ectopic pregnancy patients with intra-abdominal bleeding accompanied by cirrhosis and a history of 2 open surgeries is not easy (1 cesarean section and 1 ovarian cyst surgery). egg).

In addition to technical issues, surgeons also have to face other risks. “Surgery on cirrhotic patients is very dangerous because poor liver function can lead to two risks: the patient not waking up after anesthesia and blood clotting disorders.

That is why the anesthesia team must be very careful in anesthesia and resuscitation, using drugs that are least toxic to the liver, maintaining patient hemodynamic stability, and at the same time, during surgery, the surgeon also He must be carefully cauterized so that the patient does not bleed during and after surgery.

Furthermore, special attention must be paid to the treatment and post-operative care process. Patients are always closely monitored for vital signs, infection prevention, good liver and kidney function and prevention of complications. Other symptoms are also considered” – BCCKII Le Cong Tuoc, Director of Bac Giang Obstetrics and Pediatrics Hospital – Head of the surgical team added.

Ectopic pregnancy (or ectopic pregnancy) is a condition in which the egg after fertilization implants and develops in another location outside the uterus, most commonly in the fallopian tube (95 – 98%)…

An ectopic pregnancy is not protected by the uterine cavity, a ruptured gestational sac will cause massive bleeding into the abdominal cavity and threaten the life of the pregnant woman if emergency intervention is not promptly given. The cause of ectopic pregnancy is due to fallopian tube infection, pelvic infection, fallopian tube defects, fallopian tube stenosis or the cause may be unknown.

Hereby, Doctor Le Cong Tuoc recommends: Women who have symptoms of abdominal pain and delayed menstruation should first go to a Gynecology and Obstetrics specialist to see if the cause is pregnancy or not because it could be due to pregnancy. signs of ectopic pregnancy.

When the cause of pregnancy is ruled out , you should see other specialists. Ectopic pregnancy is something that no one wants to happen.

Therefore, women who have any signs of pregnancy should go to a specialized medical facility for examination and receive specific advice from a specialist to avoid unfortunate complications that may occur.

Solon Rutherford

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