Laparoscopic management of heterotopic pregnancy--a rare cause of acute abdomen in women.

Heterotopic pregnancy is a rare condition of coexisting intrauterine and extrauterine pregnancy and can present as an acute abdomen. The management can be challenging as the diagnosis is difficult to establish preoperatively. We report a case of a 31-year-old female presenting with acute abdominal pain and a mass in the right iliac fossa at 22 weeks of gestation. The patient was provisionally diagnosed as having an appendicular mass and was managed conservatively, however a diagnostic laparoscopy revealed the presence of an ectopic tubal pregnancy. This was successfully treated with laparoscopic right salpingectomy. A brief review of the management of heterotopic pregnancy is presented with an emphasis over laparoscopic management. The potential advantages and risks of laparoscopic approach in this situation are discussed. Laparoscopic management of these cases is possible, however, requires the availability of an experienced surgeon, trained staff, and laparoscopic equipment. Low-pressure pneumoperitoneum and use of direct vision ports for access is fundamental in achieving favorable maternal and fetal outcomes.