Spontaneous bilateral tubal pregnancy - case report and review of diagnostic and treatment difficulties

Introduction. Spontaneous bilateral ectopic pregnancy is a rare condition easily overlooked or misdiagnosed. We present a case of spontaneous bilateral tubal ectopic pregnancy and discuss the difficulties in diagnosing and treatment of such patients. Case outline. A 39-years-old patient with history of irregular and abundant menstrual cycles complained on pelvic pain and light bleeding after 55 days of amenorrhea. Ultrasound revealed enlarged uterus with a myoma and a heterogenic formation with echogenic ring sign beside the left ovary. Free fluid with cloths was present in the pelvis. As the patient was hemodynamically unstable and ectopic pregnancy was suspected emergency laparotomy was performed. During surgery we found that both tubes were significantly edematous, dilated and livid in their ampullary regions. On the left tube anterior wall rupture 15 ? 8 mm was noticeable, while right tube was intact with bleeding from its abdominal ostium. Even though the patient was not informed about the possibility of bilateral salpingectomy, after thorough consideration and due to the extent of tubal damage bilateral salpingectomy was eventually performed. Histopathological analysis confirmed presence of decidua, partially viable and partially necrotic chorionic villi and trophoblastic tissue in both left and right tube. Conclusions. Careful preoperative and intraoperative examination of both Fallopian tubes as well as the whole abdominal and pelvic cavity should be mandatory during every assessment of patients with ectopic pregnancy.