Yahouza Boka Tounga, Hamidou Soumana Diaouga, Soufianou Moumouni, Lassey James Didier, Sani Rachid

Acute generalized peritonitis revealing an ovarian pregnancy: a case report

  • General Medicine
  • Surgery
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Introduction and importance: Abdominal pregnancy is still seen in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are nonspecific, making it challenging to diagnose and often leading to delayed detection. The occurrence of an infectious complication that leads to the development of generalized acute peritonitis is rare. The author present a case of 34-year-old patient who presented with febril generalized acute peritonitis caused by an abdominal pregnancy. The result of the abdominal ultrasound and the serum β-human chorionic gonadotropin (β-HCG) level led to initial diagnostic confusion. Case presentation: A 34-year-old primigravida with no medical or surgical history of comorbidity prior consulted in our department for generalized abdominal pain in the context of fever and amenorrhoea for more than 4 months. Physical examination revealed a painful and contracted abdomen. The biological assessment showed white blood cells at 27,100/ul, the hemoglobin level at 11.8 g/dL. The serum β-human chorionic gonadotropin (β-HCG) level was less than 5 UI/L. The abdominal ultrasound noted a peritonitis secondary to an abscess of the appendix. Exploratory laparotmy revealed 200cc of pus in the peritoneum and a mass in the right iliac fossa at the expense of the ovary with agglutination of the intestines loops. After adesyolysis, a single-piece excision of the mass was performed, the break-in showing a macerated fetus, a right adnexectomy and an appendectomy. The maternal autcome was good. Clinical discussion: Abdominal pregnancy remains an inadequately diagnosed condition in developing countries. This case reminds clinicians that abdominal pregnancy remains a differential diagnosis of all abdominal pain in a woman of childbearing age including when the serum β-human chorionic gonadotropin (β-HCG) level was less than 5 ui/l. Conclusion: It is imperative to increase awareness among pregnant women about high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised.

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