Objectives: The occurrence of two pathologies at the same presentation is rare. Ectopic pregnancy is one of the differentials in a female patient of reproductive age group who presents with acute abdomen. Appendicitis is another differential that is frequently entertained.  The challenge occurs in diagnosing two pathologies occurring simultaneously, as medical practitioners generally tend to follow Occam’s razor (diagnostic parsimony). Nevertheless, we shouldn’t negate Hickman’s Dictum “Patients can have as many diseases as they damn well please”.

Method: We present an unusual case of cornual pregnancy and appendicitis occurring simultaneously in a patient. In the literature review, there have only been 23 such cases reported so far from 1960 to date.

Case Report: A 27 year old Indonesian illegal immigrant presented to our hospital with fever and lower abdominal pain. Clinically she was in sepsis. Her abdomen was tender. Vaginal examination elicited positive cervical motion tenderness and the os was open. The urine pregnancy test was positive. Transvaginal scan revealed an empty uterus with no adnexal mass or free fluid. A diagnosis of septic miscarriage was made and she was started on parenteral antibiotics, intravenous fluids, and inotrope support. After 48 hours, her condition did not improve. She was still septic and started having diarrhoea. Her abdomen became distended with evidence of peritonitis. Abdominal scan showed free fluid with dilated bowels. The total HCG had reduced from 2,035 mIU/ml to 498 mIU/ml in this period. A CT scan of the abdomen and pelvis revealed a left ruptured cornual pregnancy, hemoperitoneum, bowel oedema and bowel encasing the ectopic pregnancy. We proceeded with emergency laparotomy and on entering the abdomen, there was 150 ml of pus in the peritoneum. There was an unruptured left cornual pregnancy which was infected. Wedge resection was carried out. The surgical team removed the inflamed appendix which had a healthy base but pus in the lumen. Post-operatively she was well and advised for long acting contraception.

Conclusion: The likelihood of dual pathologies occurring simultaneously is rare, but should be entertained as was demonstrated in our case of ectopic pregnancy with appendicitis.