Ruptured abdominal ectopic pregnancy involving the appendix: a rare case managed by laparoscopic resection and appendicectomy

Abstract

Introduction: Abdominal ectopic pregnancies are uncommon (<1% of ectopics); implantation on the appendix is exceptionally rare. Concomitant appendicitis can obscure diagnosis and delay treatment.

Case report: A 30-year-old woman presented with severe right iliac fossa pain and anaemia (haemoglobin 8.6 g/dL). Urine β-hCG was positive. Pelvic ultrasound suggested a right ovarian ectopic with free fluid; abdominal ultrasound reported a normal appendix. Diagnostic laparoscopy revealed haemoperitoneum, a ruptured gestational sac adherent to an inflamed appendix, and normal uterus and adnexa, with a right corpus luteum. Laparoscopic excision of the abdominal pregnancy and appendicectomy were performed. She recovered well and was discharged on day 1. Histopathology confirmed products of conception compatible with ectopic pregnancy and acute appendicitis.

Discussion: Appendiceal involvement in abdominal ectopic pregnancy is among the rarest sites described, and concurrent appendicitis heightens diagnostic complexity. Laparoscopy enables definitive diagnosis, haemostasis, and organ-sparing resection with rapid recovery. In stable patients, early laparoscopic management is safe and fertility-preserving; laparotomy may be required when placental adhesion or bleeding risk is high. Clinicians should consider the dual pathology of ectopic pregnancy and appendicitis in women of reproductive age presenting with acute abdomen.