Intrahepatic pregnancy. A unique opportunity for evaluation with sonography, computed tomography, and magnetic resonance imaging

Laparoscopic management of primary hepatic pregnancy

“…Magnetic resonance imaging has also been reported to be useful in locating abdominal pregnancies. 5,6 One needs to have a high index of suspicion in a patient suspected of ectopic pregnancy, but presents with subtle, atypical signs and symptoms. Diagnosis was reached in our patient at laparoscopy, the gold standard for diagnosis of ectopic pregnancy.…”

Primary hepatic pregnancy

“…Among the 13 cases documented in the English‐language literature, nine cases presented with acute peritonism and hypovolaemic shock in the first trimester 1–8,12 . The remaining four cases had a less acute presentation in the second trimester 9–11,13 . Given the increase in assisted reproduction activity it is expected that primary hepatic pregnancy (PHP) will occur more frequently in the modern‐day surgical practice.…”

“…Symptoms and clinical findings are usually vague and variable. Radiological diagnosis of a PHP is equally difficult 10,11 . Haemorrhage, which is due to erosion by the trophoblastic processes into liver parenchymal vessels, is likely to be massive and often results in hypovolaemic shock.…”

“…The bleeding is usually controllable by suturing and packing. Two previously reported cases, however, were managed by wedge resection 7 and right segmentectomy 11 . In one case the surgical removal of the ectopic was considered dangerous, therefore methotrexate was injected directly into the gestational sac intraoperatively 8 .…”

“…Implantation may occur anywhere but most commonly it occurs on the surface of the pelvic peritoneum. The liver is an exceptional site of implantation, and only 13 cases have been reported in the English literature during the past 30 years 1–13 . Because of its extreme rarity, and the expectation that such occurrences will increase in the modern era of assisted reproduction, we report herewith a case of hepatic pregnancy.…”