Al Dus Ghussoun, Alhamoud Abd Ulmahdi, Ata Allah Nada, Alabdalla Joryya
Faculty of Medicine, University of Aleppo, Aleppo, Syria.
Department of Gynecology, Aleppo University Hospital, Aleppo, Syria.
Ann Med Surg (Lond). 2021 Sep 10;71:102840. doi: 10.1016/j.amsu.2021.102840. eCollection 2021 Nov.
Bilateral ectopic pregnancy is one of the rarest forms of ectopic pregnancy due to the difficulty of diagnosis and interference before surgery, where ectopic pregnancy cases are clinically indistinguishable from unilateral ectopic pregnancy, and many cases are discovered by chance during surgery.The Importance of this report comes from the history of a patient with four cesarean sections, who developed two-tailed tubal ectopic pregnancy without ovulation induction or any contraception methods.
Our patient after admission to the emergency department was diagnosed with a unilateral GS = 9W ectopic pregnancy in the right fallopian tube based on Doppler echography. However, during the surgery, the surgeon discovered a rupture in the left tube, which was discovered to be another left fallopian ectopic pregnancy confirmed by pathology.
Our patient presented with typical symptoms of ectopic pregnancy confirmed by BHCG blood test and Doppler ultra sound but the untypical finding of bilateral ectopic pregnancy without suggestive history couldn't be discovered until laparatomy.
This case reminds us to always check both adnexa before making any decisions and because of the poor presurgical diagnosis of EP, it highlights the importance of human resources and equipment which could save our patients fertility.
To preserve the integrity of the organs and the patient's future fertility the doctor who diagnoses a tubal ectopic pregnancy should always check the other tube before taking action even if the suspicion is not due to the induction of ovulation, and never fully trust imaging study only as an aiding tool to make a diagnosis; nevertheless, the patient could have been better managed and her fertility saved if better capabilities were available.
双侧异位妊娠是异位妊娠中最罕见的形式之一，原因在于手术前诊断和干预存在困难，异位妊娠病例在临床上与单侧异位妊娠难以区分，许多病例是在手术中偶然发现的。本报告的重要性源于一位有四次剖宫产史的患者，她在未进行促排卵或任何避孕措施的情况下发生了双侧输卵管异位妊娠。
我们的患者急诊入院后，根据多普勒超声检查被诊断为右侧输卵管单侧妊娠囊大小为9周的异位妊娠。然而，在手术过程中，外科医生发现左侧输卵管破裂，经病理证实为另一个左侧输卵管异位妊娠。
我们的患者表现出经血β-人绒毛膜促性腺激素检测和多普勒超声证实的异位妊娠典型症状，但直到剖腹手术才发现双侧异位妊娠这一非典型发现且无提示性病史。
该病例提醒我们在做出任何决定之前始终要检查双侧附件，并且由于异位妊娠术前诊断不佳，这凸显了人力资源和设备的重要性，它们可以挽救患者的生育能力。
为了保留器官的完整性和患者未来的生育能力，诊断输卵管异位妊娠的医生在采取行动之前应始终检查另一侧输卵管，即使怀疑并非由促排卵引起，并且绝不能仅完全依赖影像学检查作为诊断的辅助工具；然而，如果有更好的条件，患者本可以得到更好的治疗并挽救其生育能力。
