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interesting caseFrom: Dr Eberhard Lisse (el@lisse.NA)Wed Aug 9 17:29:52 2006
In May 2006 I was sent a patient with what on formal Ultrasound appeared as an anembryonic pregnancy. b-HCG was 560 and 550 two days apart, so I evacuated her. Curettings sent for histology which showed no Products of Conception. In early July a b-HCG elsewhere was 10 and I was not told about it until several paragraphs down. On July 20 she saw me for vaginal bleeding and as they are pregnant unless prooven otherwise I sent her for b-HCG and U/S. The former was not done, because the latter showed an obvious unruptured tubal pregnancy, which I removed by (converted to open) salpingectomy because the wall was beyond salvage. Histology confirmed both tubal ectopic an wall attenuation. Did not come for follow up and today pitches up at my rooms with nausea and vomiting for a few days, stools passed yesterday, and reliably tells me no intercourse since the operation. On examination there is nil of note, but sparse bowel sounds. I sent for b-HCG and on my own vaginal Ultrasound I see a 2.5 cm fluid filled area in the uterus, no grapes, and no obvious fetal parts. No pelvic mass or free fluid. b-HCG comes back 78800 (!), Hb 14.8, U&E, LFT all normal. I have asked her to come back on Friday for another b-HCG and will see her on Monday, but I have her cell phone number in case of a recall. Any clever ideas anyone? Other than a hysterectomy :-)-O el
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