Pre-operative ultrasound diagnosis and laparoscopic management of live unilateral twin tubal ectopic pregnancy: a case report

Live unilateral twin tubal ectopic pregnancy is an uncommon form of ectopic pregnancy and may be difficult to recognise before surgery. We report two women, both aged 31 years, with live unruptured left tubal twin ectopic pregnancies diagnosed on transvaginal ultrasound (TVS). Both were haemodynamically stable and presented with mild pain and vaginal spotting. TVS showed a left adnexal gestational sac separate from the ovary containing two embryos with cardiac activity. One woman had a previous interstitial ectopic pregnancy, while the other was a primigravida with no recognised risk factors for ectopic pregnancy. After counselling regarding management options, both women chose surgical treatment and underwent urgent laparoscopic left salpingectomy. Histopathology confirmed tubal pregnancy in both cases. These cases illustrate that twin tubal ectopic pregnancy can occur with or without recognised risk factors. Careful TVS assessment can establish the diagnosis before rupture and facilitate timely laparoscopic management.