Primary hepatic pregnancy

Srdjan Dikić, Željko Miković, Borislav Tošković, Svetlana Dragojević-Dikić, L Srbinović
In: Srpski arhiv za celokupno lekarstvo · 2020 · vol. 148(11-12) , pp. 773–776 · doi:10.2298/sarh200207071d · W3086755264
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This case report describes the successful surgical management of an extremely rare primary hepatic pregnancy diagnosed after initial surgery for a ruptured ovarian cyst.

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This case report describes a 40-year-old woman with a history of pelvic endometriosis who presented with acute abdominal pain and rising beta-hCG levels following surgery for a ruptured ovarian cyst. Initial laparotomy addressed the ovarian rupture, but subsequent development of upper abdominal symptoms led to a second surgery that confirmed a rare primary hepatic pregnancy. The authors highlight that delayed diagnosis in such complex presentations increases the risk of severe complications associated with ectopic gestation. This paper is centrally about endometriosis — specifically, it cites the patient's history of pelvic endometriosis as a relevant factor in her clinical presentation and infertility history.

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Abstract

Introduction. Hepatic pregnancy is an extremely rare form of ectopic pregnancy, and represents a difficult challenge for both diagnostics and treatment. Case outline. A 40-year-old gravida 0 para 0 patient in 6 + 0 gestational weeks was admitted to the hospital with lower abdominal pain, positive bHCG values, and presence of free intra-abdominal fluid. She had a history of infertility, and also a previous surgery due to pelvic endometriosis. Urgent open surgery was performed due to signs of hypovolemic shock. We discovered a rupture of the left ovarian corpus luteum cyst. Bleeding management was achieved with preservation of ovarian tissue. Patient recovered, bHCG levels continued to rise, and five days after surgery free intra-abdominal fluid reappeared with upper abdominal pain and tenderness. After transferring patient to abdominal surgery clinic, second surgery was performed, where we confirmed the presence of hepatic pregnancy. After this procedure, patient fully recovered. Conclusion. The method of choice for an ectopic pregnancy treatment is laparoscopic surgery, but when laparoscopy is not possible, the site of ectopic pregnancy could be difficult to diagnose. Prolonged time for making accurate diagnosis increases the risk of ectopic pregnancy complications.
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Srpski arhiv za celokupno lekarstvo 2020 Volume 148, Issue 11-12, Pages: 773-776 Primary hepatic pregnancy Dikić Srđan (University Hospital Medical Center Bežanijska kosa, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia) Introduction. Hepatic pregnancy is an extremely rare form of ectopic pregnancy, and represents a difficult challenge for both diagnostics and treatment. Case outline. A 40-year-old gravida 0 para 0 patient in 6 + 0 gestational weeks was admitted to the hospital with lower abdominal pain, positive bHCG values, and presence of free intra-abdominal fluid. She had a history of infertility, and also a previous surgery due to pelvic endometriosis. Urgent open surgery was performed due to signs of hypovolemic shock. We discovered a rupture of the left ovarian corpus luteum cyst. Bleeding management was achieved with preservation of ovarian tissue. Patient recovered, bHCG levels continued to rise, and five days after surgery free intra-abdominal fluid reappeared with upper abdominal pain and tenderness. After transferring patient to abdominal surgery clinic, second surgery was performed, where we confirmed the presence of hepatic pregnancy. After this procedure, patient fully recovered. Conclusion. The method of choice for an ectopic pregnancy treatment is laparoscopic surgery, but when laparoscopy is not possible, the site of ectopic pregnancy could be difficult to diagnose. Prolonged time for making accurate diagnosis increases the risk of ectopic pregnancy complications. Keywords: Hepatic pregnancy, Ectopic pregnancy, bHCG, acute abdomen https://doi.org/10.2298/SARH200207071D Full text ( 567 KB) Cited by Miković Željko (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + The Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia) Tošković Borislav (University Hospital Medical Center Bežanijska kosa, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia) Dragojević Svetlana (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + The Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia) Srbinović Ljubomir (The Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia), [email protected]

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