Simultaneous Tubal Heterotopic Pregnancy with Acute Appendicitis: A Case Report and Literature Review of 5 Cases

Heterotopic pregnancy (HP) is a serious obstetrics phenomenon that occurs when both intrauterine and ectopic pregnancies exist simultaneously. It is an extremely rare condition with potentially lifethreatening outcomes. The incidence of acute appendicitis in pregnancy is generally less common compared to the non-gravid population, and its coexistence with HP is exceedingly rare. Herein, we report a case of HP complicated with appendicitis that occurred in a 32-year-old G2P1 female presenting at 12 weeks of gestation with acute severe right lower abdominal pain. She denied any history of assisted reproductive technology or risk factors for ectopic pregnancy. On examination, the patient was conscious, oriented, afebrile, and hemodynamically stable. The abdomen was distended and tender on palpation. Pelvic ultrasonography demonstrated viable intrauterine pregnancy with a heterogenous mass within the right uterine wall with surrounding peripheral vascularity. Fluid collections were also visible in the intraperitoneal cavity. The patient underwent emergency laparotomy with right salpingectomy and appendectomy. Early diagnosis and treatment are correlated with favourable obstetrics outcomes and long-term prognosis. A surgical approach with either laparoscopy or laparotomy is more appropriate compared to medical or conservative management