An uncommon instance of bilateral ovarian teratoma with ectopic tubal pregnancy: A rare coexisting pathology

Rationale: This case report spotlights the pathologies which need immediate surgical treatment and the need for the clinicians to be diligent in assembling the differential diagnosis for acute pelvic pain. Patient Concerns: A 32-year-old female, presented with chief complaints of amenorrhea for one and a half months followed by bleeding per vaginum and lower abdominal pain for 15 days. Diagnosis: On ultrasound pelvis, there was evidence of heteroechoic collection in right adnexa with suspicious left tubal extrauterine gestational sac with yolk sac and fetal pole. Fetal heart rate was also present with surrounding collection and gestational sac. A radiological diagnosis of bilateral adnexal echogenic cyst likely teratoma with left ectopic tubal pregnancy was made. Interventions: In the present case, exploratory laparotomy followed by left salpingectomy with bilateral cystectomy was done. The treatment modality of a dermoid cyst depends upon the age of the patient. In the case of young individuals, surgeons prefer to remove the cyst only leaving behind the ovaries for hormonal benefits. Usually, cystectomy is not an emergency but sometimes due to its complications like rupture, torsion or infection medical advice is important. Outcomes: Rapid diagnosis and intervention led to improved prognosis for the patient before development of any torsion of the cyst or ruptured ectopic. Lessons: The present case highlights the challenge to clinicians and histopathologists to deal with the multiple coexisting pathologies. The clinician should have a high index of suspicion while working up a patient with acute pelvic pain.