Twin interstitial ectopic pregnancy following ipsilateral tubal pregnancy: a case report

Interstitial pregnancy has an estimated maternal mortality rate seven times greater than the mortality rate for ectopic pregnancies in general. For this reason, early diagnosis is the key to successful treatment and favorable outcomes in patients with this type of ectopic pregnancy. We report the rare case of a Portuguese white woman with a spontaneous twin interstitial pregnancy with embryonic cardiac activity, its diagnosis, and surgical management, as well as a literature review on the specificities of this scenario.

A Portuguese white woman in her early forties presented at our hospital for early pregnancy assessment 3 months after having got a salpingectomy for a tubal pregnancy. Transvaginal ultrasound revealed an empty uterine cavity and an eccentric gestational sac within the uterine serosa, containing two yolk sacs and two embryonic poles with cardiac activity. These findings were suggestive of a twin interstitial pregnancy. A cornuostomy was performed, using proximal uterine artery clipping and a purse-string suture around the cornual area as hemostatic measures. No surgical or postoperative complications occurred.

Twin tubal pregnancy is a rare occurrence, particularly in spontaneous gestations. Although interstitial pregnancies are more common after ipsilateral salpingectomy, early diagnosis is challenging. The best therapeutic approach is yet to be determined, but surgery, when indicated, offers a definitive treatment. Cornuostomy presents the advantage of removing the ectopic pregnancy while preserving uterine architecture and maintaining fertility. This case report states the relevance of early pregnancy assessment in women with risk factors for ectopic pregnancy. If performing surgery as treatment, it is advisable to adopt less invasive approaches such as cornuostomy. Also, one cannot forget the importance of maintaining a good hemostasis, considering the bleeding potential associated with this type of pregnancy.