Missed diagnosis or wrong diagnosis? Ectopic pregnancy: Double missed, and fatality thereafter

This is a case report of 36 years married female who died due to rupture of right fallopian tube ectopic pregnancy. She had pain abdomen and took consultation of two general medical practioners but none of them could recognize this and she died after five days after onset of initial symptoms. She had severe pain, intense thirst, mild fever; and diarrhea. The case highlights the commonly missed diagnosis in acute abdomen, in a female of reproductive age group. On autopsy, there was about three liter blood in peritoneal cavity. with a clot of 800 grams in pelvic cavity. The report shows photograph of rupture site of sac, and some other important findings towards evidence based autopsy. Rupture of ectopic pregnancy is fatal ifleft unattended and undiagnosed. It necessitates screening urine and blood for beta HCG for pregnancy and ultrasound before sending such a women back home, especially who was having persistent pain in the abdomen. The possibility of missed diagnosis can always be there but making no efforts at all is not justifiable. The possible differential diagnosis, methods for simple evaluation is also discussed in this case report.