A Case of Spontaneous Heterotopic Pregnancy with Tubal Rupture: Successful Management with Salpingenctomy and Continuation of Intrauterine Pregnancy

A 33-year-old primigravid presented with 2 months of amenorrhea adn an 11-day history of left lower quadrant pain. Three months prior to admission, patient underwent operative laparoscopy, bilateral salpingoneostomy for a history of primary infertility, Pelvic inflammatory disease with bilateral hydrosalpinges. Transvaginal sonography revealed simultaneous intrauterine and tubal pregnancies, with documented fetal heart activities. The patient showed signs of hemodynamic instability thus, she underwent an immediate laparotomy with left salpingectomy. Immediate surgical intervention resulted to a successful continuation of intrauterine pregnancy and avoided serious morbidity and mortality. This paper aims to discuss the diagnostic pitfalls and management of this condition.
 
Key words: Extra-uterine, Heterotopic, Intra-uterine, Rupture, Tubal, Salpingectomy, Laparoscopic salpingo-neostomy