Two embryos did not implant into the womb. A rare case of non-iatrogenic bilateral ectopic pregnancy (two-tailed tubal ectopic pregnancy) case report

Introduction and importance: Bilateral ectopic pregnancy is one of the rarest forms of ectopic pregnancy due to the difficulty of diagnosis and interference before surgery, where ectopic pregnancy cases are clinically indistinguishable from unilateral ectopic pregnancy, and many cases are discovered by chance during surgery. The Importance of this report comes from the history of a patient with four cesarean sections, who developed two-tailed tubal ectopic pregnancy without ovulation induction or any contraception methods. Case presentation: Our patient after admission to the emergency department was diagnosed with a unilateral GS = 9W ectopic pregnancy in the right fallopian tube based on Doppler echography. However, during the surgery, the surgeon discovered a rupture in the left tube, which was discovered to be another left fallopian ectopic pregnancy confirmed by pathology. Clinical Discussion: Our patient presented with typical symptoms of ectopic pregnancy confirmed by BHCG blood test and Doppler ultra sound but the untypical finding of bilateral ectopic pregnancy without suggestive history couldn't be discovered until laparatomy Conclusion: This case reminds us to always check both adnexa before making any decisions and because of the poor presurgical diagnosis of EP, it highlights the importance of human resources and equipment which could save our patients fertility. Conclusion: To preserve the integrity of the organs and the patient's future fertility the doctor who diagnoses a tubal ectopic pregnancy should always check the other tube before taking action even if the suspicion is not due to the induction of ovulation, and never fully trust imaging study only as an aiding tool to make a diagnosis; nevertheless, the patient could have been better managed and her fertility saved if better capabilities were available.