Spontaneous ruptured bilateral tubal ectopic pregnancy following natural conception: A rare case report

Ectopic pregnancy complicates 0.25%-2% of all pregnancies and is one of the most common causes of first-trimester maternal mortality in developing countries due to late diagnosis. Spontaneous ruptured bilateral tubal ectopic pregnancies are extremely rare, with very limited data on its occurrence in the literature. In a spontaneous conception, the preoperative diagnosis is difficult to make but an important one to consider at surgery for presumed unilateral tubal ectopic pregnancy because missing the diagnosis can lead to mortality. We report a case of a 38-year-old multipara with a history of amenorrhea of 8 weeks and 2 days and complaints of vaginal spotting of 4-day duration and sudden onset of abdominal pain of 4 h before presentation. On admission, a preoperative diagnosis of ruptured left tubal ectopic pregnancy was made following ultrasound findings of left adnexal mass and hemoperitoneum. However, both fallopian tubes were found to harbor ectopic gestational sac with bleeding rents on the tubal walls at surgery. She subsequently had exploratory laparotomy and bilateral salpingectomy with good outcome. In low-resource settings, ectopic pregnancy is associated with poor maternal outcome due to late presentation. Diagnosis of ruptured bilateral tubal ectopic pregnancy is difficult before surgery. Therefore, examination of both tubes at laparotomy for ectopic pregnancy should be routine and mandatory to avoid missing the diagnosis.