Chronic Tubal Ectopic Pregnancy, Surgical Case

A 33-year-old woman initially presented with clinical and paraclinical findings suggestive of a complete miscarriage. Serial serum β-hCG measurements demonstrated a spontaneous decline from 600 IU/L to 120 IU/L, and transvaginal ultrasound revealed a thin endometrium measuring 4 mm, with no evidence of an intrauterine or extrauterine gestational sac. Based on these findings, a diagnosis of complete abortion was established, and expectant management was adopted.Three weeks later, the patient re-presented with acute left iliac fossa pain. Repeat laboratory testing revealed a secondary rise in serum β-hCG to 800 IU/L. Transvaginal ultrasound demonstrated free intraperitoneal fluid, raising strong suspicion for an ectopic pregnancy.Emergency laparoscopic exploration was performed. Intraoperatively, a left-sided chronic tubal ectopic pregnancy, consistent with a tubal abortion, was identified, associated with hemoperitoneum. Notably, the ectopic gestation appeared as a well-defined intraluminal trophoblastic mass conforming to the internal contour of the fallopian tube, creating a cast-like aspect of the tubal lumen, as documented in the operative video.Given the patient’s hemodynamic stability, limited tubal involvement, and desire for future fertility, a conservative, tubal-sparing surgical approach was successfully performed, allowing preservation of the affected fallopian tube.This case highlights the atypical presentation of chronic ectopic pregnancy, in which an initial decline in β-hCG levels may be misleading, and underscores both the diagnostic value of delayed clinical presentation and the feasibility of fertility-preserving surgical management in carefully selected patients.