What are the symptoms of fallopian tube rupture?

The fallopian tube is a very important organ that is tightly attached to both sides of the female uterus. The main function of this organ is to help women ovulate. However, sometimes the fallopian tube may rupture. When it ruptures, the patient may feel pain in the lower abdomen, which will affect the normal menstrual condition and may also cause female infertility. So what are the clinical symptoms of fallopian tube rupture?

It is more common in pregnancy in the isthmus of the fallopian tube, and the onset is usually around 6 weeks of pregnancy. The fertilized egg implants between the mucosal folds of the fallopian tube. As the blastocyst grows and develops, the villi erode the muscle layer and serosa toward the tube wall, and finally penetrate the serosa, causing a ruptured fallopian tube pregnancy. The muscular layer of the fallopian tube is rich in blood vessels, and the bleeding caused by tubal pregnancy rupture is much more severe than that caused by tubal pregnancy miscarriage. A large amount of intra-abdominal bleeding can occur in a short period of time, causing the patient to fall into shock. Bleeding may also occur repeatedly, forming hematomas in the pelvic and abdominal cavities. Although tubal interstitial pregnancy is rare, the consequences are serious, and the outcome is almost always tubal rupture.

The interstitial part of the fallopian tube is the part inside the muscular wall that enters the uterine horn. The muscular layer around the lumen is relatively thick, so pregnancy can be maintained until about 4 months before rupture occurs. Because this area is rich in blood supply, its rupture is like a uterine rupture, the symptoms are extremely serious, and a large amount of intra-abdominal bleeding often occurs in a short period of time. Tubal pregnancy may lead to miscarriage or rupture. Sometimes the internal bleeding stops and the condition becomes stable. After a long time, the embryo dies or is absorbed. However, if the pelvic hematoma formed by long-term and repeated internal bleeding does not dissipate, the hematoma will become hard and adhere to the surrounding tissues, which is clinically called chronic ectopic pregnancy.

(1) Abdominal pain: Most patients come to the hospital for treatment due to sudden abdominal pain, and the incidence rate is over 90%. It often starts with severe pain in the lower abdomen on the affected side, like a tearing sensation, which may then spread to the entire abdomen. The degree and nature of the pain is related to the amount and rate of internal bleeding. If it ruptures, the internal bleeding will be large and rapid, irritating the peritoneum and causing severe pain, which may spread to the entire abdomen. If it is a fallopian tube abortion, the bleeding is less and slower, the abdominal pain is often limited to the lower abdomen or one side, and the pain is also mild. In a few cases, the amount of bleeding is heavy and the blood flows to the upper abdomen, irritating the diaphragm and causing pain in the upper abdomen and shoulders, which is often misdiagnosed as acute abdomen. Repeated rupture or miscarriage can cause repeated internal bleeding. If a single massive or multiple small amounts of internal bleeding are not treated in time, blood will coagulate in the lowest part of the pelvic cavity (rectal fossa), causing severe pain in the anus.

(2) Amenorrhea: Tubal pregnancy often causes amenorrhea. The duration of amenorrhea is mostly related to the site of tubal pregnancy. For those whose pregnancy occurs in the isthmus or ampulla, abdominal pain usually occurs around 6 weeks into the menopause and rarely lasts more than 2 to 3 months. If women with regular menstruation experience internal bleeding a few days after their menstrual period, they should consider whether it is a fallopian tube pregnancy. In interstitial pregnancy of the fallopian tube, due to the thick surrounding muscle tissue, rupture often occurs at 3 to 4 months of pregnancy, resulting in a longer period of amenorrhea. When inquiring about the medical history, you should ask in detail about the amount, quality, and duration of menstruation and compare them with previous menstruation. Do not mistake vaginal bleeding as a menstrual period. In a few cases of tubal pregnancy, the chorionic gonadotropin produced by the chorionic tissue is insufficient to induce amenorrhea in the endometrium, resulting in no amenorrhea.

(III) Irregular vaginal bleeding: After the fallopian tube pregnancy, endocrine changes occur, followed by degenerative changes and necrosis of the endometrium. The decidua is discharged in fragments or intact, causing uterine bleeding. Bleeding is often irregular, dark brown in color, and will not stop completely until the lesion is removed (by surgery or medication). In a few cases, there is heavy vaginal bleeding. In addition to the bleeding coming from endometrial exfoliation, some people believe that it comes from the fallopian tubes.