Treatment of Bilateral Tubal Ectopic Pregnancy by Conservative Tubal Surgery

Abstract

JA Unuighe, FS Shaheen, MH Hassonah, AH Abdulla, Treatment of Bilateral Tubal Ectopic Pregnancy by Conservative Tubal Surgery. 1993; 13(2): 190-193 Several reports on multiple ectopic pregnancy have inundated medical journals during the last two decades, including two recent case reports from the Middle East [1,2], each addressing combined extrauterine and intrauterine pregnancy. Many of these are associated with induction of ovulation. This case report, in addition to adding to the number of reported cases, is presented because of the peculiarity of clinical presentation and the successful conservative surgical treatment of bilateral tubal pregnancy encountered at laparotomy. Case ReportA 23-year-old Saudi female, para 1 + 0, had a cesarean section delivery two years prior to presentation. She was admitted with acute abdominal pain associated with vomiting and dysuria the night of 23 January 1992. She had seven weeks of amenorrhea with a positive report on pregnancy test conducted on an early morning specimen of urine one week prior to admission. There was no history of infertility investigation or induction of ovulation. On clinical assessment, her vital signs were stable. Examination revealed a scaphoid abdomen with marked tenderness confined to the suprapubic, iliac, and lumbar regions. No masses were palpable and there was no evidence of fluid collection. On pelvic examination, there was brown vaginal discharge. The cervix was long with a closed os and there was minimal cervical excitation pain. The uterus was slightly bulky and no adnexal masses were palpable. A diagnosis of severe urinary tract infection in early pregnancy was made. The possibility of an ectopic pregnancy was, however, entertained. Immediate microscopy on a midstream specimen of urine yielded 10-15 WBCs per high power field with a bacterial colony count greater than 10 5 /ml, and subsequent culture grew E. coli. She made remarkable clinical progress overnight while on intravenous fluid and antibiotic therapy. Ultrasonic abdominal and transvaginal pelvic scan conducted in the morning revealed a slightly bulky uterus with thickened endometrium containing some blood streaks but no fetal echos in the cavity. There was evidence of an echogenic mass 5.5 x 3.5 cm situated in the pouch of Douglas, more to the right side, with some fluid collection. Both ovaries were visualized and separate from the mass. The findings were suggestive of a right tubal ectopic gestation.On the strength of the ultrasound findings, arrangements were made for emergency exploratory laparotomy. Laparotomy was performed by excision of a wide, poorly healed, subumbilical midline keloid scar tissue.The findings at laparotomy were as follows: the uterus was within normal limits in size with no evidence of pregnancy. There was a dark brown swelling of the ampulla of the left fallopian tube, measuring about 2 cm in diameter and 3 cm in length close to the fimbria with some trickling of blood through the fimbrial ostium into the peritoneal cavity. The right ampulla contained...