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Trefsgar JR, Padgett W. Bilateral Tubal Ectopic Pregnancy: A Case Report and Review. Cureus 2024; 16:e68742. [PMID: 39371849 PMCID: PMC11455586 DOI: 10.7759/cureus.68742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
A bilateral ectopic pregnancy is a rare condition, and even more so with spontaneous conception. The known risk factors and clinical presentation are shared by both unilateral and bilateral ectopic pregnancy. This poses a risk for misdiagnosis, treatment failure, and, ultimately, maternal mortality. The current standard for diagnostics is not discernible for a bilateral ectopic pregnancy, thus, medical management tends to be sub-therapeutic. In fact, it is fairly common for the correct diagnosis and efficient treatment to be achieved by surgical intervention. As there are no established diagnostic or treatment guidelines for this rare condition, the possibility of a bilateral ectopic pregnancy should not be ruled out lightly.
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Affiliation(s)
| | - William Padgett
- Obstetrics and Gynecology, Southern Illinois Healthcare Foundation (SIHF) Healthcare, Olney, USA
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Hoorshad N, Tarafdari A, Zamani N, Hasani SS, Pasikhani MD. Bilateral tubal ectopic pregnancy following induction ovulation can be missed in emergent ultrasonography: Case report. Int J Surg Case Rep 2024; 121:109863. [PMID: 38945015 PMCID: PMC11261411 DOI: 10.1016/j.ijscr.2024.109863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Bilateral tubal ectopic pregnancy (BTP) is a rare and potentially life-threatening condition that is, often challenging to diagnose preoperatively. PRESENTATION OF CASE We present a case of BTP in a 25-year-old primigravid woman with a history of infertility due to polycystic ovarian syndrome. She was receiving letrozole when she presented with severe abdominal pain and vaginal bleeding. Initial evaluation revealed a ruptured ectopic pregnancy in the right fallopian tube, prompting an emergency laparotomy. During surgery, a second intact ectopic mass was discovered in the left fallopian tube, highlighting the diagnostic complexity of BTP. Management involved a salpingectomy on the right side and salpingostomy on the left to preserve fertility. DISCUSSION This case underscores the importance of considering BTP in the differential diagnosis of ectopic pregnancies and the necessity for thorough preoperative imaging studies, namely ultrasonography and surgical exploration, to prevent missed diagnoses. CONCLUSION BTP is a rare and challenging clinical entity that requires a comprehensive approach to diagnosis and management. Early recognition, prompt intervention, and close surveillance are essential to mitigate the risk of maternal morbidity and mortality associated with this condition.
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Affiliation(s)
- Niloofar Hoorshad
- Department of Obstetrics & Gynecology, Imam Khomeini Hospital complex, Tehran University of Medical sciences, Tehran, Iran.
| | - Azadeh Tarafdari
- Department of Obstetrics & Gynecology, Imam Khomeini Hospital complex, Tehran University of Medical sciences, Tehran, Iran
| | - Narges Zamani
- Department of Gynecology Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Sheikh Hasani
- Department of Gynecology Oncology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Deldar Pasikhani
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Imam Khomeini Hospital complex, Tehran University of Medical sciences, Tehran, Iran
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Liu Y, Li X, Liu T, Xie A, Wu X, Jia Y, Liao X, Cheng W, Wang H, Zhong F, Xu L, Huang J, Xiu S, Li Z, Li Y, Xiao X, Lin Y, Gan X. Transvaginal natural orifice endoscopic surgery for tubal ectopic pregnancy: A more suitable surgical approach for enhanced recovery after surgery. Heliyon 2024; 10:e24945. [PMID: 38312673 PMCID: PMC10835374 DOI: 10.1016/j.heliyon.2024.e24945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
Objective We aimed to determine the safety of Vaginal natural orifice transluminal endoscopic surgery (vNOTES) in terms of the Enhanced Recovery after Surgery (ERAS) concept for tubal pregnancy surgery and provide a detailed process of vNOTES for tubal pregnancy surgery, including experience and key points for surgeons performing this procedure. Methods The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 219 patients who underwent tubal ectopic pregnancy surgery between September 2021 and March 2022. The patients underwent salpingectomy or salpingostomy using transumbilical laparoendoscopic single-site surgery (LESS) or vNOTES, according to their preferences. This study prospectively collected perioperative and one-year follow-up data on tubal pregnancy outcomes after vNOTES and compared them with those after LESS. Results The vNOTES group showed a shorter surgical duration, hospitalization duration, and postoperative exhaust time and a lower analgesic medication usage rate, but it showed a higher surgical conversion rate. The vNOTES approach reduced the postoperative exhaust time by approximately 9 h (95% confidence interval [CI]: -11.93, -5.57 h, p < .001) and the risk of postoperative analgesic drug use by 77% (odds ratio, 0.23; 95% CI: 0.10, 0.61, p = .023). Conclusion vNOTES can shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and avoid surface surgical scars in tubal pregnancy surgeries, consistent with the ERAS concept. However, more comprehensive preoperative evaluation of patients who choose vNOTES is required to reduce the occurrence of intraoperative conversion.Trial registration: ChiCTR2100053483.
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Affiliation(s)
- Ying Liu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xin Li
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Tianjiao Liu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Aijie Xie
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xian Wu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yujian Jia
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiaoyan Liao
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Wei Cheng
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hui Wang
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Fangyuan Zhong
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Lijuan Xu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Juan Huang
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Siqin Xiu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Zhongzhi Li
- Department of Gynecology and Obstetrics, Chongqing University Fuling Hospital, Chongqing, 408099, China
| | - Yalan Li
- Psychiatry Department, Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, 610036, China
| | - Xue Xiao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Yonghong Lin
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiaoqin Gan
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
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