Acute abdomen as a result of unsuspected spontaneous heterotrophic pregnancy with tubal rupture: A case report and review of the literature

Background: High level of suspicion of heterotrophic pregnancy (HP) is necessary, when women within their reproductive ages present with symptoms of acute abdomen. Although regarded as a rare phenomenon, increased incidence of heterotrophic pregnancy from spontaneous and ART (assisted reproductive technology) have been observed. It could lead to life-threatening condition, if diagnosis is delayed. Spontaneous heterotrophic pregnancy is the presence of two gestations simultaneously, with an estimated prevalence of 0.08% in normal conception. Case Presentation: A 33-year-old nulliparous university student, with previous history of 4 terminations of pregnancy, and a three-year history of secondary infertility from a broken marriage was presented to our accident and emergency department as a result of acute abdomen. Urgent urine pregnancy test with a careful ultrasound assessment led to the diagnosis of a HP. Emergency surgical intervention with supportive measures resulted in a successful feto-maternal outcome as the patient had a normal delivery of a male infant at term. Conclusion: We reported a case of heterotrophic pregnancy of a patient with issues of secondary infertility for a period close to three years, who presented with acute abdomen. Considering the presentation and the increase of this phenomenon from literatures, it is therefore imperative for an adequate advocacy about this possibility during pregnancy.