P15.05: Bilateral ectopic pregnancy

Abstract

Spontaneous bilateral ectopic pregnancy is extremely rare (1 in 125–1580 ectopic pregnancies). An unusual case of ectopic pregnancy in which a patient had spontaneous, bilateral tubal pregnancy is presented. A 27 year old, pram gravida woman with history of recurrent miscarriages, complaining of abdominal pain, nausea and vaginal bleeding at 8th week of amenorrhea referred to our hospital. The patient had no history of pelvic inflammatory disease (PID), no prior use of intrauterine contraceptive device (IUD) and no use of fertility drugs. The HCG level was 19.500 IU/L. Transvaginal ultrasound showed no intrauterine pregnancy and was able to diagnose a right ectopic pregnancy, with accumulation of fluid in cul-de-sac and Morrison's pouch. On general examination, she had tachycardia and hypotension. Abdominopelvic examination revealed tenderness in the lower abdomen, tender transverse cervical movements, palpable tender right adnexal mass and fullness in all the fornices. Emergency exploratory laparotomy was performed. Hemoperitoneum of approximately 500 ml was present. On the right side, there was a ruptured fimbrial ectopic pregnancy, and the patient was bleeding from this site. The left tube showed enlarge with an unsuspected isthmic pregnancy in the left. In view of these findings, a right salpingectomy with left salpingostomy was done. The patient recovered uneventfully and was discharged on the 5th post-operative day. Histopathology showed the presence of chorionic villi in each tube. More than 200 cases of bilateral tubal ectopic pregnancy have been reported in the literature to date, most of which have occurred after some form of assisted reproductive treatment. The case reported here is interesting, as it has occurred spontaneously. Spontaneous bilateral ectopic pregnancy is a rare event and is difficult to diagnose preoperatively, demonstrating the limitation of ultrasonography in making such a diagnosis.