Spontaneous bilateral tubal ectopic pregnancy: a gynecological challenge

Bilateral ectopic pregnancy is very rare. Although the frequency of ectopic bilateral pregnancy has increased with the advent of medically assisted procreation, spontaneous bilateral tubal pregnancies remain rare. Early detection of this type of ectopic pregnancy is important to prevent maternal mortality and morbidity. Conservative surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. We report the case of a 35-year-old patient at five weeks of amenorrhea with bilateral ectopic pregnancy diagnosed based on ultrasound scans and confirmed during laparotomy. A 35-year-old woman with a history of three vaginal deliveries, non-smoker, on contraceptives (microprogestins), presented with pelvic pain and amenorrhea of five weeks. A beta HCG test came back positive. Pelvic ultrasound revealed a moderate hemoperitoneum and an empty uterus with hematometra. It also showed heterogeneous left and right adnexal masses measuring 3 cm and 4 cm, respectively. An emergency laparotomy was performed. Per-operatively, two bilateral tubal pregnancies of 3 cm and 4 cm were founded. The patient received conservative treatment with bilateral salpingotomy. Postoperative management was uneventful. The diagnosis of spontaneous bilateral tubal ectopic pregnancy is rare and often established at the time of surgery, hence the importance of a rigorous and vigilant examination of the two tubes during ultrasound examination and surgery, so as not to miss it and to better prevent maternal mortality. Conservative surgery must be carefully chosen.