Bilateral Tubal Pregnancy Complicated by Rupture of the Left Fallopian Tube

Introduction: Bilateral ectopic pregnancy is a very rare condition which occurs in 1/725 - 1/1580 ectopic pregnancies, most commonly after induced assisted reproductive techniques. Aim: To present the case of spontaneous bilateral tubal pregnancy, and the problem of insufficiency of available diagnostic methods, which causes that an accurate diagnosis can mostly be made intraoperatively. Case Report: A 37-year-old female, nulliparous, comes at the Clinic of Gynecology and Obstetrics of CCUS, complains of intense suprapubic pain, and difficulty urinating. The expected menstruation was absent for more than 2 weeks. The Grav index test was positive. Beta hCG values were 6312 IU/L. On examination, the patient was extremely pale, hypotensive, gave the impression of hemorrhagic shock, and the abdomen was diffusely palpably painful. After emergency TV ultrasound, then ultrasound and CT of the abdomen and small pelvis, which indicate a moderate amount of thicker fluid in the abdomen and small pelvis in terms of hemoperitoneum and with the left contour of the uterus an oval zone most likely to correspond to ectopic pregnancy, an indication for emergency surgery was made. A laparotomy was performed, and partly liquid and partly coagulated blood was found in the abdomen. The left tube in the isthmic part was ruptured with active bleeding. Right Fallopian tube was pathologically changed, livid, with visible suspicious pregnancy in the ampullary part. Bilateral salpingectomy was performed, and samples are sent for PHD analysis that shows the presence of chorionic villi in both tubes. Conclusion: When ectopic pregnancy is suspected, the possibility of bilateral tubal pregnancy should always be kept in mind, especially in cases accompanied by acute pelvic pain with signs of hemorrhagic shock