Spontaneous heterotopic pregnancy resulting in tubal rupture and complete spontaneous abortion: a case report in Tiko, Cameroon

A heterotopic pregnancy (HP) following spontaneous conception is a rare and potentially life-threatening condition. Its diagnosis can be overlooked, hence remaining one of the challenging gyneco-obstetrical emergencies, especially in the low-resource setting. A 24-year-old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. An abdominopelvic ultrasound showed retained products of conception, and the presence of a left adnexal mass suggestive of an extrauterine gestational sac at ~6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the hemodynamic stability of the patient prompted an emergency laparotomy to be done. The patient was transfused, postsalpingectomy counseling done and was discharged on oral analgesics, blood tonics, and antibiotics on day 6 postoperation. HP following spontaneous conception is a rare and potentially life-threatening condition. This case reports on the management of spontaneous HP resulting in a ruptured ectopic pregnancy (EP) and a complete spontaneous abortion managed in a low-resource setting. This case emphasizes the importance of a systematic ultrasound to be done for all patients with a clinically confirmed abortion to rule out an associated EP. A spontaneous abortion without signs of peritoneal irritation can be associated with an EP. Ultrasound can help in the early diagnosis, and laparotomy can be life-saving.