Ruptured Ectopic Pregnancy, Ovarian Torsion, Dermoid Cyst, Leiomyomata, and Endometriosis: A Case Report of a Pelvic Quintet

The chances of a female of reproductive age presenting with a ruptured ectopic pregnancy are relatively low. Ectopic pregnancies make up 1-2% of all pregnancies and 20% of ectopic ruptures. The chances of a patient with an ovarian torsion with a dermoid cyst are also low. The incidence of ovarian torsions is 2-5%, and a dermoid cyst is found in 25% of all ovarian torsions. The odds of a single patient presenting with both a ruptured ectopic pregnancy and ovarian torsion with a dermoid cyst, along with other pathologies, including fibroids and endometriosis, are exceptionally improbable but not impossible. We present a case of a 32year-old gravida 1 para 0000 (G1P0) female who presented to the emergency department (ED) after five weeks of amenorrhea with light vaginal bleeding and severe left lower quadrant abdominal pain. A transvaginal ultrasound (TVUS) was performed and was questionable but unclear for an ectopic pregnancy. A diagnostic laparoscopy was indicated and confirmed the diagnoses of a left ruptured ectopic pregnancy with hemoperitoneum, right ovarian torsion with a right ovarian dermoid cyst, multiple subserosal leiomyomas, and endometriosis of the posterior cul-de-sac. Given the unclear TVUS results, the ultimate decision to perform a diagnostic laparoscopy was largely based on the patient's history and presenting symptoms. This case demonstrates a pelvic quintet, five rare pelvic anomalies, in a single patient who received a potentially lifesaving salpingectomy, right cystectomy, and right ovarian detorsion.