Informed Surgical Consent - Expect the Unexpected. Discrepancies in Imaging and its Implications on Consent with Focus on Recurrent Ipsilateral Ectopic Pregnancy after Previous Salpingectomy: A case report

Most acute gynaecological admissions needing emergency surgery are either ectopic pregnancy or ovarian cysts. The ultrasound imaging plays a vital role in the diagnosis and surgical intervention is planned accordingly. It is not uncommon to confirm the side of pathology after a diagnostic laparoscopy and then continue to treat the affected side. A 38-year-old woman presented with abdominal pain 4 weeks after her last menstrual period. She had a left salpingectomy for tubal ectopic pregnancy about 8 years ago. Examination was suggestive of acute abdomen. Serum quantitative HCG was 3959 µ/l. Significant drop in haemoglobin noted within 12 hours of admission. Transvaginal ultrasonography confirmed the absence of an intra-uterine pregnancy and presence of a complex mass in the right fallopian tube. She was consented for laparoscopy and right salpingectomy based on the radiological images. Prior to the surgery, the consent form was amended to ‘laparoscopy and removal of the affected fallopian tube’. Laparoscopic evaluation revealed haemoperitoneum and ectopic pregnancy in left tubal stump. Haemoperitoneum was evacuated and the left stump was removed.

The discrepancies and errors in radiological studies should always be born in mind when deciding surgical management of a patient and addressed in taking the informed consent.

Author(s): Tabassum S, Shah A and Agrawal D

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