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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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Farshidpour LS, Vinson DR, Durant EJ. Bilateral Tubal Pregnancies Presenting 11 Days Apart: A Case Report. Clin Pract Cases Emerg Med 2023; 7:11-15. [PMID: 36859329 PMCID: PMC9983339 DOI: 10.5811/cpcem.2022.10.56910] [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] [Received: 04/17/2022] [Accepted: 10/13/2022] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Ectopic pregnancy is the most common cause of maternal mortality in the first trimester. Bilateral tubal pregnancy is the rarest subset with an estimated incidence of one in 725 to 1,580 ectopic pregnancies. Of the cases of bilateral tubal pregnancy reported in the literature, most were associated with the use of assisted reproductive techniques. Here we present the case of a patient, without a prior history of reproductive technology use, who underwent treatment for a tubal pregnancy and was subsequently found to have a second, contralateral tubal pregnancy 11 days later. CASE REPORT A 35-year-old female gravida eight para two with a history of left tubal pregnancy and salpingectomy 11 days prior, presented to the emergency department (ED) with two days of left lower and upper quadrant abdominal pain. The patient's last menstrual period had been several months prior. A physical examination revealed left lower quadrant abdominal tenderness, rebound, guarding, and left adnexal tenderness. Her vital signs were unremarkable, and her laboratory studies revealed normal white blood cell and hemoglobin values. Her human chorionic gonadotropin had tripled from her last presentation 11 days prior. Transvaginal ultrasound showed a possible ectopic pregnancy adjacent to the right ovary. She promptly underwent a right salpingectomy. Pathology findings confirmed a tubal pregnancy, and the patient's postoperative course was uneventful. CONCLUSION This case highlights the importance of maintaining a high index of suspicion for ectopic pregnancy in all biologically female patients of reproductive age who present to the ED with abdominal pain.
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Affiliation(s)
| | - David R. Vinson
- The Permanente Medical Group, Division of Research, and the CREST Network, Oakland, California,Kaiser Permanente Roseville Medical Center, Department of Emergency Medicine, Roseville, California
| | - Edward J. Durant
- The Permanente Medical Group, Kaiser Permanente Bernard J. Tyson School of Medicine, and the CREST Network, Oakland, California,Kaiser Permanente Modesto Medical Center, Department of Emergency Medicine, Modesto, California
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Kyejo W, Rubagumya D, Fidaali Z, Jusabani A, Kaguta M, Jaiswal S. Bilateral tubal ectopic gestation: Complication in a patient with previous ectopic pregnancy, rare case report. Int J Surg Case Rep 2022; 97:107470. [PMID: 35926381 PMCID: PMC9403351 DOI: 10.1016/j.ijscr.2022.107470] [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: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Ectopic pregnancy results of implantation of conceptus outside of endometrial cavity. It remains an important cause of maternal mortality. Spontaneous bilateral tubal pregnancies are the rare form of ectopic and are considered spontaneous when no fertility treatments are involved. CASE FINDINGS A 31-year-old nulliparous woman presented at the Family Medicine Clinic with complaints of non-specific mild lower abdominal pain for 3 days and amenorrhea for 5 weeks. Transvaginal Ultrasound showed bilateral unruptured adnexa pregnancies. The trial of medical therapy was done without success and later laparotomy salpingostomy was done. One year later patient was able to conceive and delivery well by cesareans section. DISCUSSION Bilateral ectopic pregnancy is a unique from of twin pregnancy frequently occurring with assisted reproductive technology rather than spontaneous pregnancy. Diagnosis of bilateral ectopic pregnancy is often challenging as the clinical symptoms and signs may not be indicative of bilateral involvement. Laboratory test with βhcg levels cannot suggestive if is unilateral or bilateral nature and sonographers may be falsely reassured if they are not careful and satisfied with visualization of ectopic gestation on one side. Laparoscopic salpingostomy or salpingectomy is the gold standard treatment modality for bilateral tubal ectopic pregnancy although laparotomy may be indicated in unstable patient. CONCLUSION AND RECOMMENDATION Therefore, any women in childbearing age presenting with clinical features of acute lower abdominal pain should be considered to have potential ectopic gestation.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania,Corresponding author.
| | - Davis Rubagumya
- Department of Family Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania,Department of Family Medicine, Premier Care Clinic Masaki, PO Box 220, Dar Es Salaam, Tanzania
| | - Zainab Fidaali
- Department of Radiology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Ahmed Jusabani
- Department of Radiology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Shweta Jaiswal
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
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Trindade VD, Burmann L, Viégas D, Hentschke MR, Azambuja R, Okada L, Petracco RG, Petracco A, Badalotti M, Michelon JDR. Ectopic pregnancy in left ovary and contralateral uterine tube diagnosed one week apart in In Vitro Fertilization with donor eggs: Case report. JBRA Assist Reprod 2019; 23:439-441. [PMID: 31294952 PMCID: PMC6798600 DOI: 10.5935/1518-0557.20190030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bilateral ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200 000 in spontaneous pregnancies. Studies have found that In Vitro Fertilization (IVF) is related to ectopic pregnancy independently, but the incidence of tubal disease in the donor egg recipient population is thought to be significantly lower than in the standard IVF population. We report the case of a patient participating in the egg-sharing program, who was diagnosed with ovarian ectopic pregnancy, treated with surgery. After one week, she was diagnosed with tubal ectopic pregnancy in the contralateral tube. The clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operatory inspection of both side fallopian tubes in any ectopic pregnancy case. Routine ultrasound after ectopic pregnancy treatment may be reasonable, especially in high risk patients.
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Affiliation(s)
- Vanessa Devens Trindade
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Lauren Burmann
- Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Dieny Viégas
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Marta Ribeiro Hentschke
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ricardo Azambuja
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Lilian Okada
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Rafaella Gehm Petracco
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Alvaro Petracco
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Mariangela Badalotti
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - João da Rosa Michelon
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
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Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy. Case Rep Obstet Gynecol 2018; 2018:7539713. [PMID: 30069421 PMCID: PMC6057319 DOI: 10.1155/2018/7539713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing management decisions based on the patient's reproductive goals and overall risk profile.
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Sampson V, Mogekwu O, Ahmed A, Bano F. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy. Case Rep Obstet Gynecol 2017; 2017:6391849. [PMID: 29090103 PMCID: PMC5635280 DOI: 10.1155/2017/6391849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 11/17/2022] Open
Abstract
Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.
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Affiliation(s)
- Victoria Sampson
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
| | - Oluremi Mogekwu
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
| | - Ammar Ahmed
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
| | - Farida Bano
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
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Abstract
The estimated prevalence of ectopic pregnancy (EP) is 1-2% worldwide. Bilateral tubal pregnancies represent the rarest form of heterotopic pregnancy, and spontaneously conceived are extremely unusual, as many cases are derived from assisted reproductive techniques. We describe a case of bilateral tubal pregnancy after clomiphene therapy and sexual intercourse in which the second EP was not contemporarily revealed.
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Affiliation(s)
- Sandro Gerli
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Claudia Giordano
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Gian Carlo Di Renzo
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
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