Laparoscopic Salpingectomy for Heterotopic Pregnancy: A Case Report from Ile-Ife,Nigeria

Abstract

Abstract

Background: Heterotopic pregnancy in a spontaneous conception is a rare and life-threatening condition. With its high rate of twin gestation and ectopic pregnancy, a country such as Nigeria might be expected to have a higher incidence of heterotopic pregnancy. The use of laparoscopic surgery in the management of heterotopic pregnancy has been widely reported, but none has been documented in Nigeria. Case: This report presents a 24-year-old G3, P1011 admitted with severe right iliac fossa pain in pregnancy at 13 weeks' gestation, with stable vital signs. An ultrasound scan revealed a normal intrauterine pregnancy with a heterogeneous right adnexal mass; hence, a right ovarian cyst accident in pregnancy was suspected. Emergency laparoscopy, however, revealed a slow leaking right ampullary tubal pregnancy coexisting with a normal intrauterine gestation. The patient underwent a laparoscopic right salpingectomy with continuation of the intrauterine pregnancy. Results: The pregnancy had progressed to 21 weeks' gestation when this case report was written. Conclusions: Spontaneous heterotopic pregnancy is usually misdiagnosed, possibly because it is a very rare condition. Laparoscopic surgery is the preferred mode of management, although not well-established in resource-poor settings. This case is therefore presented to demonstrate that, with appropriate adaptation and improvisation, laparoscopic management of heterotopic pregnancy can be safely accomplished even in a resource-poor setting, with a satisfactory outcome. (J GYNECOL SURG 29:96)