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Heterotopic pregnancy (HP), i.e. the simultaneous
development of an intrauterine and an ectopic
pregnancy, is rare with a reported incidence of
between 1:2600 and 1:30000. Only a few cases
have been described in the literature. We report
here on an extremely rare case of HP after natural
conception with cardiac activity noted on sonography
in both the intrauterine and the ectopic
foetus. Examination excluded appendicitis. Vaginal
sonography (VS) was performed and revealed
a second, extrauterine foetus with cardiac activity.
The differential diagnosis included twin pregnancy
in a bicornuate uterus, but HP could not be
excluded. Diagnostic laparoscopy was scheduled
due to progressive abdominal pain. Shortly before
surgery the patient became acutely hypotensive.
Laparoscopy confirmed a heterotopic pregnancy
in the right tube. Due to acute rupture of the extrauterine
pregnancy with intraabdominal bleeding,
the procedure was converted to a laparotomy
with right-sided salpingectomy. Subsequently,
the intrauterine pregnancy continued without
complications. The intrauterine pregnancy was
uneventful with spontaneous delivery at term.