Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature

Abstract

Objective: To report a case of primary hepatic pregnancy complicated by acute hemoperitoneum that was treated with a laparoscopic approach.

Design: Case report and review of the literature.

Setting: Obstetrics and gynecology unit of a university hospital.

Patient(s): A 37-year-old pregnant woman who presented with vaginal bleeding.

Intervention(s): Diagnosis by abdominal ultrasound and computed tomography.

Main outcome measure(s): Patient recovery after minimally invasive laparoscopic surgery and monitoring.

Result(s): A hepatic ectopic pregnancy complicated by hemoperitoneum was diagnosed. The hepatic pregnancy was surgically removed via laparoscopy through a retroperitoneal approach, and the patient's human chorionic gonadotropin level was subsequently monitored. The patient's postoperative course was uneventful, and the serum human chorionic gonadotropin level dropped to zero.

Conclusion(s): Only 39 cases of hepatic pregnancy have been reported in the literature, making it an exceptional category among abdominal pregnancies. Hepatic localization should be ruled out in cases of unknown pregnancy location. Abdominal ultrasound has a key role detecting hepatic localization and excluding other abdominal implantation sites. Laparoscopic surgery represents a feasible approach for the treatment of first trimester hepatic pregnancies.

Keywords: Abdominal pregnancy; ectopic pregnancy; hemoperitoneum; hepatic pregnancy; laparoscopy.