Simultaneous fallopian tube and duodenal serosal ectopic pregnancies from a spontaneous conception: a case report.

OBJECTIVE

To present a case report of two concurrent ectopic pregnancies (EP), in a disparate distal location within abdominal cavity with potential life-threatening consequences.

DESIGN

Case report.

SETTING

In-patient acute hospital admission.

PATIENT(S): A multiparous woman with two children and a previous right tubal pregnancy treated with laparoscopic salpingectomy, who initially presented with an acute abdominal pain and vaginal bleeding suspicious of an EP. Having had the EP confirmed and treated with laparoscopic salpingectomy, she presented again 3 weeks later with acute abdominal pain, whereupon further evaluation an EP was found on the serosal surface of the second part of the duodenum.

INTERVENTION(S): Laparoscopy and laparotomy followed by excision of the duodenal EP.

MAIN OUTCOME MEASURE(S): Recovery to health and discharge from hospital.

RESULT(S): Tissue histologic confirmation of left fallopian tubal EP, duodenal (second part) serosal EP, and return of β-hCG level <1 IU/L.

CONCLUSION(S): Maternal deaths from failure to manage EPs appropriately remain prominent. This case report underscores the importance of vigilance at initial laparoscopic surgery and the need to reconsider the presence of another EP in any subsequent acute presentation within a short time of discharge. A mandatory, postoperative β-hCG level monitoring following treatment of all EPs would have alerted to an unusual clinical situation.