Intrauterine and ruptured tubal ectopic pregnancy: a diagnostic challenge

A case of combined pregnancy, an unusual condition, is presented. A 17-year-old woman came to the emergency department because of left-sided, low abdominal pain. An intrauterine pregnancy and a right-sided ovarian cyst were demonstrated by ultrasound. The presence of the intrauterine pregnancy caused the clinicians to disregard symptoms and physical findings suggesting the concomitant presence of a ruptured left tubal ectopic pregnancy. Forty-eight hours later, when the patient was in impending shock, laparotomy revealed the ruptured left tubal ectopic pregnancy. Surgical treatment was successful. Six weeks later, a blighted ovum was removed from the uterus, confirming that two pregnancies had coexisted. Undue reliance on ultrasonography is criticized, and culdocentesis is advocated.