Enhancing Detection and Management of Spontaneous Bilateral Ectopic Pregnancies: Insights From a Rare Case.

BACKGROUND Ectopic pregnancy is a common gynecological emergency occurring when fertilization implants outside the uterine cavity. Bilateral tubal ectopic pregnancy (BTP), in which there are simultaneous pregnancies in both fallopian tubes, is exceedingly rare. BTP diagnosis is challenging as symptoms mimic unilateral cases, and imaging often fails to identify both sites. No standardized follow-up protocols exist, leading to potential clinical oversight and delayed management. While BTP is more commonly associated with assisted reproductive technologies, spontaneous cases are even rarer. CASE REPORT We present a case of spontaneous BTP in a 28-year-old woman initially treated for unilateral ectopic pregnancy. Transvaginal ultrasonography suggested a right tubal ectopic pregnancy, but laparoscopy revealed a left ectopic pregnancy, requiring salpingectomy. Despite the discrepancy between imaging and surgical findings, no additional follow-up was arranged. The patient re-presented 17 days post-surgery with persistent abdominal pain and shoulder tip pain. Initially diagnosed as postoperative infection, subsequent ultrasound revealed a live ectopic pregnancy in the right tube. Emergency surgery confirmed a ruptured right tubal pregnancy necessitating a second salpingectomy. CONCLUSIONS This rare case highlights the diagnostic challenges of bilateral ectopic pregnancies and emphasizes the need for thorough examination of both fallopian tubes during assessment and surgery. When discrepancies exist between imaging and intraoperative findings, clinicians should maintain vigilance for BTP. This case demonstrates the need for comprehensive postoperative monitoring when imaging-surgical discrepancies occur. Clinicians should consider bilateral ectopic pregnancy when patients present with persistent symptoms following treatment for unilateral ectopic pregnancy. Improved awareness and standardized protocols could enhance early detection and preserve fertility in these rare cases.