A Case of Severe Diffuse Abdominal Pain: What's Your Diagnosis?

A 24-year-old woman presented to the ER with acute abdominal pain. Prior to her ER visit, she only had mild to moderate lower abdominal pain for one week, and intermittent vaginal spotting for three months.

Physical examination Pulse rate: 146 beats/minute Blood pressure: 114/72 mmHg Peritoneal signs with diffuse abdominal tenderness, muscle guarding, and rebounding pain Laboratory examination Normocytic Anemia Hemoglobin: 6.6 g/dL Hematocrit: 19.9% Beta-HCG levels: 163,663.2 mIU/mL Radiological findings Transabdominal ultrasound (Figure 1) showed an empty uterus, a 6 cm crown-rump length (CRL) live fetus about 12 weeks of gestation of uncertain location, and massive hemoperitoneum Contrast-enhanced CT scan (Figure 2) revealed that the placenta was located in the right adnexa, without omental and bowel, and other peritoneal cavity seeding. The patient recovered well and was later…