Spontaneous Bilateral Tubal Ectopic Pregnancy: Incidental Finding During Laparoscopy – Brief Report and Review of Literature

Abstract

Objective: Bilateral tubal ectopic pregnancies are rare; the reported incidence is only 1 in 200?000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because of the associated morbidity and mortality. The appropriate fertility-preserving surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. Case Report: A 39-year-old gravida 2, para 1 presented with vaginal bleeding at 8?+?4 weeks of gestation. An approximately 18?mm adnexal mass in the right fallopian tube was detected on ultrasound. Laparoscopy was performed because ectopic pregnancy was suspected. This suspicion was confirmed during laparoscopy; the right fallopian tube was found to contain a mass measuring 20?mm in the isthmic part. Ultrasound of the left fallopian tube also showed a mass in the ampullary region (diameter: 10?mm), also suspicious for ectopic pregnancy. Bilateral salpingotomy was performed laparoscopically. Pathological examination confirmed the diagnosis. Conclusions for Practice: Although ectopic tubal pregnancy is seen more often after assisted reproductive techniques, bilateral spontaneous ectopic pregnancies must also be considered in other cases. Laparoscopic surgery is effective to confirm the diagnosis and treat heterotopic pregnancies. Further studies will be needed to confirm whether unilateral or bilateral conservative fertility-preserving surgery is more appropriate.

Heterotopic Pregnancy with Intrauterine Device: A Typical Case Report

“…Laparoscopy often be considered as a safe option among most of the clinicians, because it offers both diagnosis and management and allows for minimal handling of the uterus. If the patient wants to keep the intrauterine fetus, laparoscopy is an ideal choice; the outcome of the intrauterine pregnancy is comparable to that obtained with laparotomy [12][13][14][15]. Our reported case is an unintended pregnancy with IUD, so the patient selected artificial abortion to terminate the intrauterine pregnancy before the found of coexistent ectopic pregnancy.…”

Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy

“…In the literature, the majority of cases are managed with bilateral salpingectomy [14, 15]. There have been cases of successful conservative surgery [6] but also cases associated with persistent symptoms requiring further surgery or treatment with methotrexate [16, 17]. …”

“…Bilateral tubal ectopic pregnancies (BEPs) are a very rare form of ectopic pregnancy [5], and incidence has been reported as 1 in 725 to 1 in 1580 of ectopic pregnancies equating to approximately 1 in 200,000 pregnancies [6]. …”

Bilateral Tubal Molar and Embryonic Pregnancy

“…The management of extra-uterine pregnancy is variable [9] which can be medical, surgical conservative or radical according to multiple criteria [18]. Evolution is generally favorable [2] [19].…”

“…However, the conservative treatment exposes the risk of recurrence of extra-uterine pregnancy and the persistence of trophoblastic disease for the molar component [18] [20]. Also, it would not significantly improve fertility [18] [21].…”