Primary hepatic pregnancy

Rare Ectopic Pregnancies - A Literature Review for the Period 2007 - 2019 on Locations Outside the Uterus and Fallopian Tubes

The majority of ectopic pregnancies (EP) are tubal pregnancies, but other implantation sites outside the uterus and tubes are also found. These rare EP locations present a particular diagnostic and therapeutic challenge. We present an overview of potential very rare locations of ectopic pregnancies, their symptoms, diagnosis and treatment, based on a systematic analysis of case reports. A literature review of the databases PubMed, Livivo and Google Scholar for the period 2007 to 2019 was carried out. A total of 113 publications were included in our review. These studies describe EP implantations in the posterior cul-de-sac, on the uterine serosa and uterine ligaments, in the vicinity of almost all intraperitoneal organs, on the abdominal wall as well as in retroperitoneal sites. The most common presenting symptom was abdominal pain occurring in different locations. The diagnostic procedures included various imaging procedures and/or explorative surgery at different advanced stages of pregnancy. The most common and preferred option was laparotomy for surgical treatment. The placenta was successfully resected in the majority of cases. A rare EP location should be considered when making a differential diagnosis in patients of child-bearing age with abdominal pain.

Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome: A case report

RATIONALE

Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. This study aimed to report a case of primary hepatic pregnancy in a patient with polycystic syndrome.

PATIENT CONCERNS

A 30-year-old woman presented with vaginal bleeding after 63 days of amenorrhea.

DIAGNOSIS

The patient was initially diagnosed with liver ectopic pregnancy using abdominal ultrasound and abdominal computed tomography (CT).

INTERVENTIONS

The patient underwent laparoscopic exploration to reconfirm the gestational sac in the liver and abdominal surgery to remove liver gestation. The postoperative review of abdominal CT and the level of serum human chorionic gonadotropin (hCG) was performed.

OUTCOMES

The postoperative pathological examination revealed a fluffy tissue in the liver tissue and a blood clot. The patient's vital signs were normal, and she was advised regular follow-up after discharge from the hospital. One month later, the serum hCG level reduced to 0.32 mIU/mL (reference range 0-5 mIU/mL).

LESSONS

If the level of beta-human chorionic gonadotropin (β-HCG) is higher than normal in women of childbearing age and no gestational sac is found in the uterine cavity, the location of pregnancy and gestational sac should be positively confirmed. Also, the possibility of ectopic pregnancy in the abdominal cavity should be considered, and the relevant imaging and biochemical examinations should be improved to avoid delay in diagnosis and treatment.

Successful management of diaphragmatic ectopic pregnancy using ultrasound-guided percutaneous microwave ablation

Diaphragmatic ectopic pregnancy is a rare status during the perinatal period. We reported that a 24-year-old woman with diaphragmatic ectopic pregnancy successfully received ultrasound-guided percutaneous microwave ablation. It found that beta-human chorionic gonadotropin level decreased showing 1067, 311.3 and 118.4 mIU/mL within five postoperative days, and P level reduced from 3.64 to 1.59 nmol/L. Contrast-enhanced ultrasonography image on the third day after ablation indicated that there was no enhancement in the lesion. This case indicated that ultrasound-guided percutaneous microwave ablation could be critical for a good outcome in diaphragmatic ectopic pregnancy.

Ectopic pregnancy in the liver incidentally diagnosed by imaging: A case report

The present report describes the case of a 31-year-old woman diagnosed with an ectopic pregnancy in the liver. The patient presented with amenorrhea for 40 days and abdominal distention for 27 days. A liver mass had been detected 6 days prior to presentation. Using ultrasound (US), a hyperechoic mass with a fluid sonolucent area was detected in the right hepatic lobe. Examination by computed tomography (CT) revealed the presence of a mass in the right hepatic lobe with a slightly low-density peripheral region and an oval central portion of lower density in the plain scan; the enhanced scan revealed a significantly enhanced peripheral region and a non-enhanced central portion. ¹⁸F-fluodeoxyglucose (FDG) positron emission tomography (PET)-CT showed a mass in the right hepatic lobe with an increased intake of FDG in the peripheral region (maximum standard uptake value, 5.7) and a non-increased intake of FDG in the central portion. The patient was then subjected to hysteroscopy and laparoscopy. Histopathologically, the mass was an ectopic pregnancy. The patient recovered following the surgery. In conclusion, a timely diagnosis of ectopic pregnancy was made for a 31-year-old women with an ectopic pregnancy in the liver on the basis of US, CT and PET-CT imaging results, which enabled surgery to be undertaken prior to any serious consequences. These observations may be helpful for the diagnosis of similar cases in the future.

Successful medical treatment of a hepatic pregnancy: a case report

Background

Hepatic pregnancy is a rare form of abdominal pregnancy, often documented only as case reports.

Case presentation

We report here the case of a 24-year-old African woman, gravida 4 para 3, presenting with right upper quadrant pains and metrorrhagia after amenorrhea of 8 weeks 5 days. Elements in favor of the diagnosis of hepatic pregnancy were her clinical presentation, the kinetics of β-human chorionic gonadotropin titers, and the presence of a sub-hepatic mass on ultrasound. We successfully treated this patient with intramuscular methotrexate only.

Conclusions

The interest of this case resides in the rarity of this condition and the therapeutic approach used. Clinicians should raise their index of suspicion for hepatic pregnancy when faced with females of reproductive age with such a clinical presentation.