title: Heterotopic pregnancy following bilateral tubal ligation: case report.
abstract: METHODS
  A 38-year-old woman presented, one year after bilateral tubal ligation, with vaginal bleeding, vomiting, and stupor. Ten days earlier, she had submitted to a dilatation and curettage for an unexpected intrauterine pregnancy. At the time of this presentation there was rebound tenderness and guarding on abdominal examination, and a 2.5 cm right adnexal mass was detected on transvaginal ultrasound together with free fluid in the pelvis. The serum level of beta-hCG was 8522 mIU/ml. At laparoscopy a right tubal pregnancy and a large haematocele in the pouch of Douglas were detected. A right salpingectomy and a bipolar electrocoagulation of the left tubo-cornual junction were performed laparoscopically.
  
  
  CONCLUSIONS
  Pregnancy after tubal sterilisation may be heterotopic and this possibility should be considered in the differential diagnosis.
authors.affiliation: Department of Obstetrics and Gynaecology, Firat University, School of Medicine, Elazig, Turkey. bkumbak@yahoo.com
authors.forename: Banu
authors.initials: B
authors.lastname: Kumbak
authors.forename: Zehra Sema
authors.initials: ZS
authors.lastname: Ozkan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Simsek
mesh_terms: D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D058994:Salpingectomy; D013246:Sterilization, Tubal; D014463:Ultrasonography
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human