Spontaneous bilateral tubal ectopic pregnancy preoperatively diagnosed by the ultrasound: a case report

Abstract

Background Bilateral ectopic pregnancy is extremely rare, with a tremendous maternal mortality and morbidity risk, requiring rapid diagnosis and management. This condition is usually diagnosed during surgery, as radiologists may not pay enough attention to the contralateral side of interest. Therefore, reminding of this rare but emergent situation can be beneficial for both radiologists and gynecologists. Here we report a case of bilateral ectopic pregnancy, which was first diagnosed with ultrasound and was confirmed during laparoscopy. Case presentation A 34 years old woman complaining of light vaginal bleeding at 6 weeks of gestation by her last menstrual period presented to our institute. The serum β-HCG levels were analyzed and followed during patient’s admission. Unfortunately, serum levels weren’t decreasing and blood test titration before surgery were as: 851,894,975 IU/l (checked daily and not every 48 h because of patient’s status and being bilateral). There was no evidence of intrauterine pregnancy at the transvaginal ultrasound, but heterogeneous adnexal masses were seen at both adnexa, suspected of bilateral ectopic pregnancy. She underwent laparoscopic exploration, which confirmed the diagnosis. Bilateral salpingostomy was done to preserve fertility, and the patient’s recovery was uneventful. Conclusions Even with a unilateral report of ectopic pregnancy preoperatively in ultrasonography, surgeons should always be aware of the probability of bilateral ectopic pregnancies anytime facing susceptible cases, especially in patients with known risk factors. Also, it is an important reminder for radiologists to check both adnexa when facing a unilateral adnexal mass resembling ectopic pregnancy.

Bilateral tubal ectopic pregnancy following induction ovulation can be missed in emergent ultrasonography: Case report

“…US: ultrasound, G: gravidity, P: parity, MVB: mild vaginal bleeding, MTX: methotrexate, PG: primigravid. First author Year Age Gestational age Gravidity Previous history of infertility Risk factors Presentation US findings Treatment Eghbali et al [ 9 ] 2023 34 6 weeks G2, P1 9 years None MVB 13 mm adnexal mass in the right and 21 mm in the left Laparoscopic bilateral salpingostomy Damiani et al [ 5 ] 2020 33 7 weeks G2, P1 Not mentioned IVF MVB Mass of 17 × 17 mm in the right adnexa Laparoscopic bilateral salpingectomy Fukuda et al [ 10 ] 2014 32 6 weeks G1, P1 Clomiphene citrate for ovulatory disturbance None Intermittent pain Left adnexal mass of 9 cm in diameter Laparoscopic left salpingectomy, and linear right salpingotomy Mansouri et al [ 11 ] 2023 22 6 weeks G2 2.5 mg/day Letrozole administration for 10 days None MVB, abdominal pain and spotting Complex mass (50 ∗ 70 mm) in left adnexa, intact right tube Left laparoscopic salpingostomy for the first episode, and MTX therapy for the second episode Gerli et al [ 12 ] 2016 32 5 weeks PG Clomiphene 50 mg twice a day for five days Smoking Abdominal pain A gestational sac with a yolk sac close to the right ovary. Normal left adnexa Right salpingectomy for the first episode and laparoscopic left salpingotomy for the second episode.…”