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Jing MMD, Yuchen WMD, Xiaohui SMD, Aiqing ZMD, Bo Z. Ectopic Pregnancy Implanted in the Diaphragm: A Case Report and Literature Review. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2021.200065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Wu QL, Wang XM, Tang D. Ectopic pregnancy implanted under the diaphragm: A rare case report. World J Clin Cases 2021; 9:11437-11442. [PMID: 35071575 PMCID: PMC8717506 DOI: 10.12998/wjcc.v9.i36.11437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/08/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal pregnancy is a rare type of ectopic pregnancy. We describe here a case of ectopic pregnancy implanted under the surface of the diaphragm, presenting the particular features of imaging findings from ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).
CASE SUMMARY A 30-year-old woman presented with complaint of intermittent abdominal pain, that had begun 5 d earlier. She had no current or abnormal vaginal bleeding, and her serum human chorionic gonadotropin level (13372.08 IU/L) indicated pregnancy. Vaginal ultrasound showed a mixed echogenic mass in the right ovary. CT (plain) scan showed a curved high density mass beneath the subhepatic space. MRI scan showed a curved mixed signal, with restricted diffusion beneath the subhepatic space. Abdominal ultrasound demonstrated a mixed echogenic mass in the right lobe of the liver near the apex of the diaphragm, with a visible yolk sac and germ cell region with a bud. Subsequent laparoscopy visualized a dark red mass under the right diaphragm, which was resected completely. Histopathological examination of the resected mass confirmed an ectopic pregnancy. The recovery was swift and uneventful, and the patient was discharged to home.
CONCLUSION Ectopic pregnancy should be in the differential diagnostic workup (via multiple imaging modalities) of childbearing woman with unexplained abdominal pain.
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Affiliation(s)
- Qiang-Le Wu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Xiao-Man Wang
- Department of Ultrasound, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Dong Tang
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
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Muroni M, Butoyi JMV, Shimirimana M, Mulemangabo M, Nkurunziza J, Caravaggi P. Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review. Int J Surg Case Rep 2021; 80:105694. [PMID: 33676289 PMCID: PMC7982487 DOI: 10.1016/j.ijscr.2021.105694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Advanced abdominal pregnancy (> 20 weeks gestation) is a rare condition life-threatening for mother and fetus. CASE PRESENTATION A 31-years-old African woman presented from a rural district to Mutoyi Hospital for first gynecological evaluation after 37 weeks of amenorrhea, abdominal pain and vaginal bleeding. An ultrasound revealed an extra-uterine fetus. Laparotomy was done and a live fetus weighing 1980 g was delivered. Removal of the placenta, triggered massive bleeding (5000 mL) with shock. After re-laparotomy for post-operative ileus and hemoperitoneum, the mother and infant were discharged in good health. CLINICAL DISCUSSION Viable fetus can be delivered after an advanced abdominal pregnancy. Removal of the placenta is controversial. We review currently medical literature on advanced abdominal pregnancy and propose a management of the placenta in these patients. CONCLUSION We recommended to leave the placenta in situ, to avoid intraoperative bleeding. Placenta involution during follow-up can be revealed by ultrasound, colordoppler and β-hCG serum level decrease.
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Affiliation(s)
- Mirko Muroni
- Mutoyi Hospital, General Surgery Department, Gitega, Burundi.
| | | | | | | | - Joel Nkurunziza
- Mutoyi Hospital, General Surgery Department, Gitega, Burundi
| | - Paola Caravaggi
- Mutoyi Hospital, Obstetrics and Gynecology Department, Gitega, Burundi
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Eisner SM, Ebert AD, David M. Rare Ectopic Pregnancies - A Literature Review for the Period 2007 - 2019 on Locations Outside the Uterus and Fallopian Tubes. Geburtshilfe Frauenheilkd 2020; 80:686-701. [PMID: 32675831 PMCID: PMC7360401 DOI: 10.1055/a-1181-8641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/19/2020] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Sophie M. Eisner
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow Klinikum, Berlin, Germany
| | - Andreas D. Ebert
- Praxis für Frauengesundheit, Gynäkologie und Geburtshilfe, Berlin, Germany
| | - Matthias David
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow Klinikum, Berlin, Germany
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5
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Zhang N, Yang L, Wang Y, Li X, Zhang C, Xu J. Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome: A case report. Medicine (Baltimore) 2020; 99:e19649. [PMID: 32221090 PMCID: PMC7220081 DOI: 10.1097/md.0000000000019649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Ning Zhang
- School of Clinical Medicine, Jining Medical University
| | | | | | - Xiaoyu Li
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Chao Zhang
- School of Clinical Medicine, Jining Medical University
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Zhao RF, Huang SR, Xu LL, Liu NP, Liang N. Successful Management of a Live 14-week Primary Hepatic Ectopic Pregnancy Combined with a Residual Horn of the Uterus Using Laparoscopy. Chin Med J (Engl) 2018; 130:3013-3014. [PMID: 29237941 PMCID: PMC5742936 DOI: 10.4103/0366-6999.220298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Ren-Feng Zhao
- Department of Gynecology and Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
| | - Shun-Rong Huang
- Department of Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
| | - Li-Li Xu
- Department of Gynecology and Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
| | - Ni-Ping Liu
- Department of Gynecology and Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
| | - Ning Liang
- Department of Anesthesia, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
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7
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Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature. Fertil Steril 2018; 110:925-931.e1. [DOI: 10.1016/j.fertnstert.2018.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
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8
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Diagnosis and management of primary hepatic pregnancy: literature review of 31 cases. Arch Gynecol Obstet 2018; 298:235-242. [DOI: 10.1007/s00404-018-4781-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
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Karpathiou G, Kassir R, Berremila SA, Camy F, Peoc'h M. Liver ectopic pregnancy complicating a focal nodular hyperplasia. Pathology 2018; 50:478-479. [PMID: 29731143 DOI: 10.1016/j.pathol.2017.11.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 11/13/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Georgia Karpathiou
- Department of Pathology, North Hospital, University Hospital of St-Etienne, France.
| | - Radwan Kassir
- Department of Bariatric Surgery, University Hospital Felix-Guyon, La Réunion, France
| | - Sid Ali Berremila
- Department of Pathology, North Hospital, University Hospital of St-Etienne, France
| | - Florian Camy
- Department of Pathology, North Hospital, University Hospital of St-Etienne, France
| | - Michel Peoc'h
- Department of Pathology, North Hospital, University Hospital of St-Etienne, France
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10
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Zhang S, Sun Q, Jiang X, Gao F. Clinical significance of expression of hsa-mir-1247 and hsa-mir-1269a in ectopic pregnancy due to salpingitis. Exp Ther Med 2018; 15:4901-4905. [PMID: 29805512 PMCID: PMC5952075 DOI: 10.3892/etm.2018.5998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/15/2018] [Indexed: 12/12/2022] Open
Abstract
The clinical significance of hsa-mir-1247 and hsa-mir-1269a expression in ectopic pregnancy due to salpingitis was investigated. Eighty patients with ectopic pregnancy diagnosed by ultrasonography who were admitted to Jinan Maternity and Child Care Hospital from January 2012 to May 2012 were enrolled in this study. To the observation group were assigned 35 patients whose ectopic pregnancy was due to salpingitis. The remaining 45 patients whose ectopic pregnancy was due to reasons other than endometriosis were assigned to the control group. Moreover, 32 healthy pregnant women were enrolled in this study at the same time as the healthy control group. Compared with the healthy control group, hsa-mir-1247 and hsa-mir-1269a were downregulated and upregulated, respectively, in patients with ectopic pregnancy (P<0.05). The difference was even more marked in patients with ectopic pregnancy due to salpingitis (P<0.05). The expression levels of hsa-mir-1247 and hsa-mir-1269a were negatively correlated, and the correlation coefficient r and P-value was -0.667 and 0.006, respectively. Abnormal expression of hsa-mir-1247 and hsa-mir-1269a may be risk factors for ectopic pregnancy. Abnormal expression of hsa-mir-1247 and hsa-mir-1269a found in patients with ectopic pregnancy due to salpingitis may be used as biomarkers of ectopic pregnancy.
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Affiliation(s)
- Suxia Zhang
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
| | - Qian Sun
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
| | - Xiaojuan Jiang
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
| | - Fengchun Gao
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
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11
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Primary hepatic pregnancy. Clin Res Hepatol Gastroenterol 2017; 41:241-242. [PMID: 27939097 DOI: 10.1016/j.clinre.2016.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/24/2016] [Accepted: 10/24/2016] [Indexed: 02/04/2023]
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12
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Cai YY, Xiao EH, Shang QL, Xiao LZ. Ectopic pregnancy in the liver incidentally diagnosed by imaging: A case report. Exp Ther Med 2017; 14:373-376. [PMID: 28672941 DOI: 10.3892/etm.2017.4478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 03/17/2017] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Ye-Yu Cai
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - En-Hua Xiao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Quan-Liang Shang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Li-Zhi Xiao
- Department of PET-CT, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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Yanaihara A, Ohgi S, Motomura K, Hagiwara Y, Mogami T, Saito K, Yanaihara T. An abdominal ectopic pregnancy following a frozen-thawed ART cycle: a case report and review of the literature. BMC Pregnancy Childbirth 2017; 17:108. [PMID: 28388882 PMCID: PMC5383944 DOI: 10.1186/s12884-017-1294-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 03/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ectopic pregnancy (EP) occurs in 1% of pregnancies and is reported to be more common in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancies. An abdominal ectopic pregnancy (AEP) is a rare form of EP, and there are few reports of an AEP after IVF/ICSI. In this case report, a rare case of AEP after frozen-thawed cycle of ICSI is presented. Case presentation After a frozen-thawed cycle of ICSI, the beta-human chorionic gonadotropin (HCG) level at 4 weeks 0 days of gestation was 3.4 IU/L. Subsequent dysfunctional uterine bleeding was mistaken for menstruation; however, an AEP of 9 weeks with a fetal heart beat was observed by ultrasound. After the AEP was observed by ultrasound, it was extracted laparoscopically. Conclusion A rare case of an AEP, which developed after frozen-thawed cycle of ICSI, presented with a very low serum HCG level. Even if the HCG titer is low, follow-up HCG levels and frequent medical examinations are necessary.
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Affiliation(s)
- Atsushi Yanaihara
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan.
| | - Shirei Ohgi
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
| | - Kenichirou Motomura
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
| | - Yuko Hagiwara
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Tae Mogami
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Keisuke Saito
- Department of Obstetrics & Gynecology, Women's Health, Yokohama City University Hospital, 3-9 Fukuura Kanazawa-ku, Yokohama, Zip 236-0004, Japan
| | - Takumi Yanaihara
- Yanaihara Women's Clinic, 1-26-29 Ofuna, Kamakura, Kanagawa, Zip247-0056, Japan
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Sibetcheu Tchatou A, Tchounzou R, Mbuagbaw L, Mboudou ET. Successful medical treatment of a hepatic pregnancy: a case report. J Med Case Rep 2017; 11:70. [PMID: 28292325 PMCID: PMC5351162 DOI: 10.1186/s13256-017-1227-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/30/2017] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- A Sibetcheu Tchatou
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - R Tchounzou
- Gynaecology and Obstetrics Unit, Douala Gynaeco-Obstetric and Paediatric Hospital, Douala, Cameroon
| | - L Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - E T Mboudou
- Gynaecology and Obstetrics Unit, Douala Gynaeco-Obstetric and Paediatric Hospital, Douala, Cameroon
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Abstract
Hepatic ectopic pregnancy is an uncommon form of extrauterine pregnancy. A 31-year-old woman had acute abdominal pain and distention. Laboratory examination showed significantly increased serum β-human chorionic gonadotropin level. Both ultrasound and MRI identified a lesion located at the right lobe of the liver. FDG PET/CT was performed to determine whether the other causes of elevated β-human chorionic gonadotropin level, which showed an oval mass with mid peripherally increased FDG activity. After surgery, pathological results confirmed a diagnosis of hepatic ectopic pregnancy.
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Harirah HM, Smith JM, Dixon CL, Hankins GDV. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases. AJP Rep 2016; 6:e301-8. [PMID: 27595049 PMCID: PMC5008960 DOI: 10.1055/s-0036-1588003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/14/2016] [Indexed: 12/27/2022] Open
Abstract
Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy.
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Affiliation(s)
- Hassan M. Harirah
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - J. Michael Smith
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - C. Luke Dixon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Gary D. V. Hankins
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
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