RUPTURED ECTOPIC PREGNANCY PRESENTING AS ACUTE APPENDICITIS WITH A FALSE NEGATIVE URINE PREGNANCY TEST IN A LIMITED RESOURCE SETTING: A CASE REPORT

Abstrak

Background: Ectopic pregnancy is a potentially life-threatening condition that requires prompt diagnosis and management. However, its clinical presentation can be variable and may mimic other causes of acute abdomen, particularly in limited resource settings. The presence of a false-negative urine pregnancy test further complicates the diagnostic process. Case Presentation: A 30-year-old woman presented to the emergency department with a 2-day history of right lower abdominal pain accompanied by fever, nausea, vomiting, and fatigue. She reported irregular menstrual cycles and a history of vaginal spotting one week prior, with a negative home urine pregnancy test. On examination, the patient was hemodynamically unstable, with hypotension, tachycardia, and signs of peritoneal irritation, including positive McBurney and psoas signs. Laboratory findings showed mild anemia and leukocytosis. Based on clinical findings, an Alvarado score of 8/10 suggested probable acute appendicitis. However, bedside ultrasonography revealed significant free intraperitoneal fluid and a right adnexal mass consistent with ectopic gestation. The patient was diagnosed with ruptured ectopic pregnancy with hypovolemic shock. Initial management included fluid resuscitation followed by referral to a higher-level facility for definitive surgical treatment. Discussion:  This case highlights the diagnostic challenge of ectopic pregnancy, particularly when classical symptoms are absent and urine pregnancy tests yield false-negative results. Limited access to advanced diagnostic tools, such as serum β-hCG, further complicates decision-making in primary care settings. Bedside ultrasonography plays a crucial role in early detection and differentiation from other causes of acute abdomen. Conclusion: Ectopic pregnancy should always be considered in women of reproductive age presenting with acute abdominal pain, regardless of urine pregnancy test results. Strengthening the diagnostic capacity of general practitioners, particularly in basic obstetric ultrasonography, is essential to improve early recognition and reduce morbidity and mortality in resource-limited settings.