A rare and unusual case of bilateral tubal ectopic pregnancies

A report describes a case of a 25-year-old patient, Gravida 2, Para 1 with one living issue, with 2 months amenorrhea, who presented with bleeding per vaginum for 5 days and pain in the lower abdomen for 10 days. She was married for the last 3 years and had one male child of 2 years. Her past menstrual cycles were regular and described no history of any drug taken or previous surgery.

General examination revealed tachycardia (pulse of 110/min), hypotension (blood pressure of 90 mmHg systolic) and pallor.

Abdominopelvic examination revealed tenderness in the lower abdomen, tender transverse cervical movements, palpable tender right adnexal mass and fullness in all the fornices. Colpopuncture revealed Hemoperitoneum.

An emergency exploratory laparotomy was carried out which revealed hemoperitoneum of approximately 400 ml. On the right side, a ruptured fimbrial ectopic pregnancy was observed causing the bleed. While the left tube showed an organized hematoma of size 2 x 3 cm, protruding from the antimesenteric border in the ampullary region which was not bleeding, suggestive of an old ruptured tubal ectopic pregnancy. Given these findings, a right salpingectomy with left salpingostomy was performed. The hematoma on the left side was excised along with a thin rim of the tube and hemostasis was achieved by under-running the salpingostomy incision. The patient recovered uneventfully and was discharged on the 7th day postoperatively.

Histopathology of the specimens confirmed the diagnosis of right ruptured fimbrial ectopic and left chronic ruptured tubal ectopic pregnancy.

Kansaria J, Chauhan A, Mayadeo N. An unusual case of bilateral tubal ectopic pregnancy. Case reports. https://www.bhj.org.in/journal/2002_4401_jan/case_116.htm

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