Intrahepatic Pregnancy - A Rare Form Of Abdominal Pregnancy At Lira Regional Referral Hospital, Northern Uganda; A Case Report And Literature Review

Primary intra-hepatic pregnancy is an extremely rare condition. The purpose of this study was to report a case of 24-year-old Gravida 2 para 1+0 who presented at 35 weeks of amenorrhea, vaginal bleeding and mild right upper abdominal tenderness. Ultrasonography revealed a non-viable extra-uterine fetus located around the right upper part of the abdomen with a bulky uterus. At laparotomy was preferred and on finding a fetus free abdominal cavity and uterus, a macerated female baby was delivered from inside the liver with birth weight of 2.7kilogram. Placenta was left in situ and methotrexate given to hasten its resorption. Maternal outcome during the 18 days of intense follow up was uneventful. This case is a rare occurrence in our setting and it has diagnostic challenges in low resource settings like ours, however intra-hepatic pregnancy can grow to considerable size and weight.

Primary hepatic pregnancy

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 hospital with lower abdominal pain, positive bHCG values, and presence of free intraabdominal 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 rupture of 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 intraabdominal 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. 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.