Özet:

Objective: Heterotopic pregnancy that rarely occurs in natural conception is often diagnosed after its rupture when surgical treatment is needed. Therefore early diagnosis is vital for the patients. We introduced a heterotopic pregnancy case presenting with a ruptured tubal pregnancy and later cornual pregnancy. Case Presentation: A 24 year old, nulliparous, 7 weeks pregnant woman in natural conception was admitted with abdominal pain and vaginal bleeding. Physical examination revealed the signs of acute abdomen. Gestational sac was not observed in endometrial cavity by transvaginal ultrasound. Endometrium was 15 mm and hyperechoic. Ruptured ectopic focus in the right tuba and free fluid in the douglas pouch were observed. Hemoglobin level was 9.2 g / dl and β-hcg level was 3028.3 m IU / mL. After the evaluation of the patient laparoscopy was planned. In laparoscopy; the right fallopian tube had ruptured. Right salpingectomy and then D & C were performed. Right tubal pathological evaluation was ectopic pregnancy, and hematosalpinx and pathologic assessment of the D & C material came as Arias Stella reaction. β-hcg level was 481.4 m IU / mL on the second postoperativeday and the patient was evaluated by transvaginal ultrasonography. Endometrium was 10 mm and heterogeneous. Post-operative 4thday β-hcg level was 6446.9 m IU / mL and transvaginal ultrasonography was repeated. Gestational sac and yolk sac were visible at the right cornual area. Patient was treated with systemic methotrexate (75 mg / m2) subsequently. Conclusion: The rarity of heterotopic pregnancy may lead to delays in diagnosis and treatment. The diagnosis of cornual pregnancy was delayed after the removal of tubal pregnancy by exploration. We would like to draw attention of physicians with such a rare case in order to improve patients' outcomes and to introduce the importance of serial β-hcg follow-ups in these patients. Keywords: Heterotopic pregnancy; cornual pregnancy; tubal ectopic pregnancy.

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