Abstract:

Ectopic pregnancy (EP) is one of the common acute abdominal conditions in gynecology. Multiple ectopic pregnancy (MEP) is often associated with assisted reproductive technology, while spontaneous multiple ectopic pregnancy (SMEP) is rarely reported. Its diagnosis and differential diagnosis are challenging, leading to a high rate of misdiagnosis. This report presents a case of SMEP. The patient presented with a 4-year history of dysmenorrhea and one episode of prolonged menstruation. Imaging studies suggested a left ovarian endometriotic cyst and a right uterine leiomyoma. During surgery, blue-purple masses were observed at the left tubal isthmus and the right uterus cornu, leading to a tentative diagnosis of left tubal isthmic pregnancy and leiomyoma of the right uterine wall. Laparoscopic procedures including left tubal methotrexate injection, right salpingectomy, right cornual pregnancy removal, and peritoneal drainage were performed. Postoperative pathological examination confirmed a left old tubal isthmic pregnancy and a right cornual pregnancy. By discussing the reasons for misdiagnosis, diagnosis, and differential diagnosis in this case, we aim to enhance clinicians' understanding of SMEP, aiming to improve its preoperative diagnostic accuracy and reduce the misdiagnosis rate.

Key words: Pregnancy, ectopic, Pregnancy, interstitial, Pregnancy, cornual, Diagnostic errors, Diagnosis, differential, Therapy