P34.12: The use of laparoscopic ultrasound in an unusual case of bilateral ectopic pregnancies: a case report

Abstract

The patient was a 33 years old lady with secondary infertility. She was referred to our unit for left tubal ectopic pregnancy at six weeks of gestation. The pregnancy was conceived by ovulation induction and intrauterine insemination. She complained of small amount of vaginal bleeding. There was no abdominal pain. Clinical examination was unremarkable. Transvaginal ultrasound showed thickened endometrium. The ovaries were multicystic and enlarged, which was compatible with the history of ovarian stimulation. There was a gestational sac with fetal pole measuring 2.6 mm at the left adnexa. The diagnosis was left tubal ectopic pregnancy and the patient was counseled for laparoscopic left salpingectomy. During the operation, however, both fallopian tubes were found swollen. There was difficulty in deciding the site of the actual ectopic pregnancy and hence, the side requiring salpingectomy. Laparoscopic ultrasound has been used in our unit for detecting pelvic nodal metastasis in cervical carcinoma. The laparoscopic ultrasound probe is a multi-frequency (5.0-, 6.5-, and 7.5-MHz) probe measuring 10 mm in diameter. (Panther Ultrasound Scanner System, B&K, Denmark). Between 0.5 L and 1 L of normal saline is required to provide an acoustic window for the ultrasonography. In order to proceed with appropriate surgical treatment, we performed laparoscopic ultrasound along the bilateral swollen fallopian tubes. Scanning of the left tube showed the presence of a gestational sac with a fetal pole measuring 3.9 mm with pulsation. Unexpectedly, there was a gestational sac measuring 1.5cm in the right tube. Therefore, laparoscopic left salpingectomy and right salpingotomy were performed. Pathological examination confirmed the left tubal ectopic pregnancy and the presence of products of gestation from the right tube. Our case demonstrated the potential role of laparoscopic ultrasound in delineating the location of the ectopic pregnancy in situations with equivocal clinical findings.