Unilateral Twin Tubal Ectopic Pregnancy: A Case Report with Integrated Obstetric–Gynecologic and Anatomical Pathology Evaluation at Restu Ibu Sragen General Hospital, Indonesia

Onnie Wira Tama; Indah  Sri Astuti; Rusnita  Rusnita

doi:10.58344/ihj.v5i3.984

Authors

Onnie Wira Tama Rumah Sakit Umum Restu Ibu Sragen
Indah Sri Astuti Rumah Sakit Umum Restu Ibu Sragen
Rusnita Rusnita Rumah Sakit Umum Daerah dr. Soeratno Gemolong

DOI:

https://doi.org/10.58344/ihj.v5i3.984

Keywords:

twin ectopic pregnancy, tubal pregnancy, fallopian tube, transvaginal ultrasonography, salpingectomy

Abstract

Unilateral twin tubal ectopic pregnancy is a rare obstetric condition that presents diagnostic challenges and carries a risk of potentially life-threatening hemorrhage. This case report aimed to describe the clinical, ultrasonographic, surgical, and histopathological findings of a right-sided unilateral twin tubal ectopic pregnancy and assess the concordance among these diagnostic modalities. A retrospective descriptive case study was conducted at Restu Ibu Sragen General Hospital, Indonesia, with histopathological examination performed at Soeratno Gemolong General Hospital. Clinical data were obtained from medical records, archived ultrasonographic images, operative documentation, and histopathology reports. Transvaginal ultrasonography, supplemented by color Doppler imaging and four-dimensional (4D) ultrasonographic rendering, revealed an empty uterine cavity, a pelvic hematocele, and two gestational sacs containing embryos in the right adnexal region. No embryonic cardiac activity was detected in either embryo. Emergency laparotomy revealed an enlarged, hemorrhagic right fallopian tube, prompting right salpingectomy. Gross pathological examination identified two embryos within the fallopian tube, while histopathological evaluation demonstrated chorionic villi, trophoblastic cells, and blood clots, without evidence of malignancy. The concordance among ultrasonographic, intraoperative, and histopathological findings supported the diagnosis of a right-sided unilateral twin tubal ectopic pregnancy and demonstrated the complementary roles of these diagnostic approaches. This case emphasized the importance of systematically assessing and documenting the number of gestational sacs and embryos during adnexal ultrasonography and correlating imaging findings with surgical and histopathological examinations. An integrated multidisciplinary approach facilitated comprehensive diagnostic confirmation; however, findings from a single case could not establish diagnostic accuracy or the comparative effectiveness of treatment modalities.

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