{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:14:40Z","timestamp":1779196480699,"version":"3.51.4"},"reference-count":17,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,2]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>We present a case of a woman in her 20s with right iliac fossa pain. Initial investigations showed mildly elevated inflammatory markers and serum beta human chorionic gonadotrophin (hCG) &lt;1 mIU\/mL. She was taken to theatres as a presumed early appendicitis but found to have haemoperitoneum with a free-floating cystic structure in the pouch of Douglas with intact pelvic organs. This was subsequently confirmed histologically as a gestational sac which had likely been expelled via the abdominal ostia into the peritoneal cavity (a so-called complete tubal abortion). She made a good postoperative recovery and was discharged with no complications. This case highlights the rare but important potential for ectopic pregnancy and its complications to be present despite a negative serum beta-hCG.<\/jats:p>","DOI":"10.1136\/bcr-2025-271693","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:55:20Z","timestamp":1779195320000},"page":"e271693","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopy-confirmed complete tubal abortion of an ectopic pregnancy with undetectable urine and serum beta-hCG levels"],"prefix":"10.1136","volume":"19","author":[{"given":"Katie","family":"Collis","sequence":"first","affiliation":[{"name":"Emergency Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoaib","family":"Ashfaq","sequence":"additional","affiliation":[{"name":"Ealing Hospital, Southall, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Cirelli","sequence":"additional","affiliation":[{"name":"Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemant","family":"Sheth","sequence":"additional","affiliation":[{"name":"Surgery, Ealing Hospital, Southall, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"2026051905551336000_19.5.e271693.1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14189"},{"key":"2026051905551336000_19.5.e271693.2","unstructured":"Hoffman BL , Schorge JO , Bradshaw KD , et al . Ectopic pregnancy. 3rd ed. New York, NY: Access Medicine, McGraw-Hill Education, 2016."},{"key":"2026051905551336000_19.5.e271693.3","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/00003081-198703000-00022","article-title":"Tubal abortion and infundibular ectopic pregnancy","volume":"30","author":"Caspi","year":"1987","journal-title":"Clin Obstet Gynecol"},{"key":"2026051905551336000_19.5.e271693.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2012.10.053"},{"key":"2026051905551336000_19.5.e271693.5","unstructured":"Betz D , Fane K . Human chorionic gonadotropin (hCG). National Library of Medicine, StatPearls Publishing; 2023. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532950\/"},{"key":"2026051905551336000_19.5.e271693.6","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31829c6ed6"},{"key":"2026051905551336000_19.5.e271693.7","first-page":"559","article-title":"Ectopic pregnancy with shock and undetectable beta-human chorionic gonadotropin. A case report","volume":"32","author":"Lonky","year":"1987","journal-title":"J Reprod Med"},{"key":"2026051905551336000_19.5.e271693.8","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1067\/mem.2002.125446","article-title":"Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result","volume":"40","author":"Kalinski","year":"2002","journal-title":"Ann Emerg Med"},{"key":"2026051905551336000_19.5.e271693.9","first-page":"282","article-title":"A unique case of ruptured ectopic pregnancy in a patient with negative preg-nancy test - a case report and brief review of the literature","volume":"18","author":"Daniilidis","year":"2014","journal-title":"Hippokratia"},{"key":"2026051905551336000_19.5.e271693.10","first-page":"7154713","article-title":"A Ruptured Ectopic Pregnancy Presenting with a Negative Urine Pregnancy Test","volume":"2016","author":"Sheele","year":"2016","journal-title":"Case Rep Emerg Med"},{"key":"2026051905551336000_19.5.e271693.11","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s10397-008-0411-0","article-title":"Laparoscopic removal of a large 8-cm ectopic pregnancy with a negative pregnancy test","volume":"6","author":"Alfhaily","year":"2009","journal-title":"Gynecol Surg"},{"key":"2026051905551336000_19.5.e271693.12","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.radcr.2023.11.002","article-title":"Sonographic findings of complete tubal abortion","volume":"19","author":"Sherer","year":"2024","journal-title":"Radiol Case Rep"},{"key":"2026051905551336000_19.5.e271693.13","first-page":"45","article-title":"Haemoperitoneum due to Tubal Abortion in a Patient with Negative Urine Pregnancy Test\u2014Case Report and Literature Review","volume":"6","author":"Tse","year":"2006","journal-title":"Hong Kong J Gynaecol Obstet Midwifery"},{"key":"2026051905551336000_19.5.e271693.14","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3109\/00016349709050078","article-title":"Ruptured ectopic pregnancy with undetectable beta-hCG levels coexisting with acute appendicitis","volume":"76","author":"Bozoklu","year":"1997","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026051905551336000_19.5.e271693.15","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318190a2bb"},{"key":"2026051905551336000_19.5.e271693.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(00)00233-X"},{"key":"2026051905551336000_19.5.e271693.17","first-page":"94","article-title":"Ruptured tubal ectopic pregnancy with negative serum beta hCG--a case for ongoing vigilance?","volume":"122","author":"Lee","year":"2009","journal-title":"N Z Med J"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271693","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:55:23Z","timestamp":1779195323000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":17,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2025-271693"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271693","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}