FALLOPIAN TUBE - Twin ectopic pregnancy

The tube is greatly distended and opened to show 2 gestational sacs - the larger contains a 5 cm foetus and shows placental tissue in the wall over an area some 5 cm across. The 2nd sac contains a barely recognisable foetus approximately 1.5 cm in length, only the umbilical cord can be clearly made out. In the wall there are areas of bloodclot, foetal death has obviously occurred sometime before.
This woman presented some 3 months after her last menstrual period with occasional spotting. A pregnancy test was reported as negative - approximately 1 week later she presented again with abdominal pain radiating to the shoulders - a pregnancy test was reported as positive. Laparoscopy showed the presence of blood in the abdomen, both recent and old, and laparotomy followed with removal of the left tube.