Farshidpour Leyla S, Vinson David R, Durant Edward J
University of California Davis School of Medicine, Sacramento, California.
The Permanente Medical Group, Division of Research, and the CREST Network, Oakland, California.
Clin Pract Cases Emerg Med. 2023 Feb;7(1):11-15. doi: 10.5811/cpcem.2022.10.56910.
Ectopic pregnancy is the most common cause of maternal mortality in the first trimester. Bilateral tubal pregnancy is the rarest subset with an estimated incidence of one in 725 to 1,580 ectopic pregnancies. Of the cases of bilateral tubal pregnancy reported in the literature, most were associated with the use of assisted reproductive techniques. Here we present the case of a patient, without a prior history of reproductive technology use, who underwent treatment for a tubal pregnancy and was subsequently found to have a second, contralateral tubal pregnancy 11 days later.
A 35-year-old female gravida eight para two with a history of left tubal pregnancy and salpingectomy 11 days prior, presented to the emergency department (ED) with two days of left lower and upper quadrant abdominal pain. The patient's last menstrual period had been several months prior. A physical examination revealed left lower quadrant abdominal tenderness, rebound, guarding, and left adnexal tenderness. Her vital signs were unremarkable, and her laboratory studies revealed normal white blood cell and hemoglobin values. Her human chorionic gonadotropin had tripled from her last presentation 11 days prior. Transvaginal ultrasound showed a possible ectopic pregnancy adjacent to the right ovary. She promptly underwent a right salpingectomy. Pathology findings confirmed a tubal pregnancy, and the patient's postoperative course was uneventful.
This case highlights the importance of maintaining a high index of suspicion for ectopic pregnancy in all biologically female patients of reproductive age who present to the ED with abdominal pain.
异位妊娠是孕早期孕产妇死亡的最常见原因。双侧输卵管妊娠是最罕见的类型，估计在725至1580例异位妊娠中发生率为1例。在文献报道的双侧输卵管妊娠病例中，大多数与辅助生殖技术的使用有关。在此，我们报告一例患者，该患者既往无生殖技术使用史，曾接受输卵管妊娠治疗，11天后被发现对侧输卵管又发生妊娠。
一名35岁女性，孕8产2，11天前有左侧输卵管妊娠及输卵管切除术史，因左下和上腹部疼痛2天就诊于急诊科。患者末次月经已过去数月。体格检查发现左下腹压痛、反跳痛、肌紧张及左侧附件压痛。生命体征无异常，实验室检查显示白细胞和血红蛋白值正常。人绒毛膜促性腺激素水平较11天前上次就诊时增加了两倍。经阴道超声显示右卵巢旁可能存在异位妊娠。她随即接受了右侧输卵管切除术。病理结果证实为输卵管妊娠，患者术后恢复顺利。
该病例强调了对于所有因腹痛就诊于急诊科的育龄期女性患者，都要高度怀疑异位妊娠的重要性。
