Bilateral tubal ectopic pregnancy after spontaneous conception

Česká verzia

Authors: R. Botsyurko ¹ ; V. Smoligová ²
Authors place of work: Gynekologicko-porodnické oddělení, Mulačova nemocnice Plzeň ¹; Gynekologicko-porodnická klinika LF UK a FN Plzeň ²
Published in the journal: Ceska Gynekol 2023; 88(4): 287-290
Category: Case Report
doi: https://doi.org/10.48095/cccg2023287

Summary

Objective: Presentation of a case report of a rare case of bilateral tubal pregnancy in a female patient after spontaneous conception. Observation: We present a case of a 26-year-old female patient first hospitalized in the Gynecology Obstetrics Clinic of the Pilsen University Hospital, where a laparoscopy was indicated for suspicion of ectopic tubal pregnancy during which a left-sided salpingectomy was performed for a macroscopically clear finding of a tubal pregnancy on the left side, this finding was also confirmed histologically. Subsequently, the patient was discharged to home care. During a follow-up examination by a district gynaecologist, the patient complained of a recurrence of pain in the lower abdomen, on collection of hCG (human chorionic gonadotropin) its increase was detected and the patient was sent for a control gynaecological examination to Mulacova Hospital in Pilsen. On the examination in the outpatient clinic, she reported significant lower abdominal pain and collapsed during transvaginal ultrasound and was hospitalized. Subsequently, diagnostic laparoscopy was indicated during hospitalization, during which tubal pregnancy on the right and hemoperitoneum were macroscopically evident. A right-sided salpingectomy was performed for this finding with subsequent hCG drop, resolution of the discomfort and histological confirmation of tubal pregnancy on the right. Conclusion: The incidence of such cases without prior ovulation stimulation is 1 out of 200,000 pregnancies and an estimated 1 out of 725 to 1 out of 1,580 ectopic pregnancies. Even so, bilateral tubal or heterotopic ectopic pregnancy should be considered in the differential diagnosis, as both conditions can be immediately life-threatening.

Keywords:

heterotopic pregnancy – ectopic pregnancy – bilateral tubal pregnancy

Zdroje

1. Roztočil A et al. Moderní gynekologie. Praha: Grada publishing 2011.

2. Hoffmann S, Abele H, Bachmann C. Spontaneous bilateral tubal ectopic pregnancy: incidental finding during laparoscopy – brief report and review of literature. Geburtshilfe Frauenheilkd 2016; 76 (4): 413–416. doi: 10.1055/s-0041-110394.

3. Andrews J, Farrell S, Andrews J. Spontaneous bilateral tubal pregnancies: a case report. J Obstet Gynaecol Can 2008; 30 (1): 51–54. doi: 10.1016/S1701-2163 (16) 32713-X.

4. Ramadan M, Kharroubi M, Bou-Ghanem R et al. Bilateral tubal pregnancy following spontaneous conception: a case report and literature review. J Clin Gynecol Obstet 2020; 9 (3): 60–69. doi: 10.14740/jcgo642.

5. Eghbali E, Azari M, Jafarizadeh A et al. Spontaneous bilateral tubal ectopic pregnancy preoperatively diagnosed by the ultrasound: a case report. BMC Pregnancy Childbirth 2023; 23 (1): 125. doi: 10.1186/s12884-023-05458-z.

6. Xu H. A spontaneous bilateral tubal pregnancy: a case report. Medicine (Baltimore) 2018; 97 (38): e12365. doi: 10.1097/MD.0000000000012365.

7. Li W, Wang G, Lin T et al. Misdiagnosis of bilateral tubal pregnancy: a case report. J Med Case Rep 2014; 8: 342. doi: 10.1186/1752-1947-8- 342.

8. Kyejo W, Rubagumya D, Fidaali Z et al. Bilateral tubal ectopic gestation: complication in a patient with previous ectopic pregnancy, rare case report. Int J Surg Case Rep 2022; 97: 107470. doi: 10.1016/j.ijscr.2022.107470.

9. Benardete HD, Meraz ÁD, Álvarez VR et al. Spontaneous tubal bilateral ectopic pregnancy. An Med Asoc Med Hosp ABC 2017; 62 (3): 208–212.

10. Marino S, Canela CD, Nama N. Tubal sterilization. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023 [online]. Available from: https: //www.ncbi.nlm.nih.gov/books/NBK470377/.

11. Homagain S, Kharal N, Khanal H et al. Ruptured ectopic pregnancy on a tubal stump: a case report. Clin Case Rep 2022; 10 (9): e6305. doi: 10.1002/ccr3.6305.

12. Hloušková L, Hudeček R, Eim J. Laparoskopická sterilizace bilaterální salpingektomií – profylaktický benefit a raritní komplikace. Ceska Gynekol 2020; 85 (5): 328–332.