June 20th, 2018

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Omental Implantation Secondary to Ruptured Tubal Pregnancy with a Negative Urine Pregnancy Test: A Case Report
Authors:  Suk Woo Lee, M.D., Hyun Joo Choi, M.D., Ph.D., Yoon Kyung Lee, M.D., and Joo Hee Yoon, M.D., Ph.D.
BACKGROUND: The first steps in the diagnosis of an ectopic pregnancy are to use a sensitive qualitative urine test to detect the b-subunit of human chorionic gonadotropin (b-hCG) and to perform a transvaginal ultrasonography. A negative urine pregnancy test result is generally used to exclude an ectopic pregnancy; however, a few studies have reported the presence of a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result. Furthermore, because secondary omental implantation (SOI) is rare and probably underestimated or misdiagnosed, a case of an SOI with a negative urine hCG test has never been reported.

CASE: This was a very rare case of an SOI from a ruptured tubal pregnancy in a patient with an initial series of negative urine pregnancy tests and decreased levels of serum b-hCG. The SOI was managed with laparoscopy.

CONCLUSION: For patients diagnosed with tubal or ovarian pregnancy who have negative urine pregnancy test results and decreased levels of serum b-hCG, late-onset omental implantation should be considered as a possibility.
Keywords:  ectopic pregnancy, HCG-beta, hemoperitoneum, omentum
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