Ruptured primary intrahepatic ectopic pregnancy: A case report and review of literature

Table 1 Blood examination

Investigations	Value	Normal range
Hemoglobin	6.9 g/dL	13.0-17.0
TLC	9.3 × 103/µL	4.0-10.0
Platelets	118.0 × 103/µL	80.0-140.0
Liver function tests
Serum GOT	43.0 IU/L	0.0-35.0
Serum GPT	35.0 IU/L	0.0-41.0
ALP	102.0 IU/L	40.0-129.0
Albumin	2.8 g/dL	3.5-5.2
Bilirubin	0.4 mg/dL	0.1-1.2
Renal function tests
Serum urea	43.0 mg/dL	17.0-43.0
Serum creatinine	0.6 mg/dL	0.6-1.1
Serum uric acid	3.2 mg/dL	2.6-6.0
Serum Na+	139.0 mmol/L	136.0-145.0
Serum K+	3.4 mmol/L	3.5-5.0
Viral markers
HCV	Non-reactive
HBsAg	Non-reactive
HIV	Non-reactive
β-hCG	43760 IU/mL

TLC: Total lymphocyte count; ALP: Alkaline phosphatase; GOT: Serum glutamic oxaloacetic transaminase; GPT: Glutamic pyruvic transaminase; hCG: Human chorionic gonadotropin; HCV: Hepatitis C virus; HBsAg: Hepatitis B surface antigen.

Table 2 Postoperative day 1 blood exams

Investigations	Value	Normal range
Hemoglobin	9.0 g/dL	13.0-17.0
TLC	8.1 × 103/µL	4.0-10.0
Platelets	110.0 × 103/µL	80.0-140.0
Electrolytes
Serum Na+	139.0 mmol/L	136.0-145.0
Serum K+	3.5 mmol/L	3.5-5.0
β-hCG	3333 IU/mL

TLC: Total lymphocyte count; hCG: Human chorionic gonadotropin.

Table 3 Literature review of all cases of primary hepatic pregnancy from the last 10 years

Ref.	Age	Symptoms	Investigation/findings	Management	Points
Zhao et al[21], 2017	21	Vaginal bleeding with no abdominal pain and 14-week pregnancy	β-hCG: 135755.00 IU/L, USG abdomen revealed a live 14-week fetus attached to the undersurface of the left hepatic lobe. CT scan showed a 7 cm fetus between left liver lobe and gall bladder	Laparoscopy excision and extraction of the amniotic sac as well as a 12-cm long fetus	N/A
Yin et al[22], 2018	28	Abdominal pain and RUQ tenderness, amenorrhea for 30 days	β-hCG: 1579 IU/mL, USG abdomen revealed 74 mm × 31 mm with an uneven high echo at recessus hepatorenalis. CT revealed a mass in the right hepatic lobe	Laparotomy and removal of the ectopic foci along with the clots	A contraceptive ring had been placed in the uterine cavity 3 years prior
Garzon et al[23], 2018	37	Vaginal bleeding and amenorrhea for 9 weeks	β-hCG: 8707 IU/mL, USG abdomen revealed a mixed echogenic mass in the hepatic area. CT scan showed hemoperitoneum and a round 25-mm lesion in the VI hepatic segment	Retroperitoneal laparoscopic approach with visualization of the ectopic tissue in segment VI, subsequent excision of the foci and hemostasis were achieved with 3800 mL intraoperative blood loss	Inconclusive initial diagnostic laparoscopy leading to re-exploration and additional surgery
He et al[24], 2019	23	Persistent dullness and abdominal pain in RUQ	USG abdomen revealed 11.0 cm × 8.9 cm mixed cystic and solid hyperechoic mass attached to the right liver lobe	N/A	History of cesarean section and intake of oral contraceptives within 6-months of presentation
Zhang et al[25], 2020	30	Vaginal bleeding and amenorrhea for 63 days	β-hCG: 17193 IU/mL, USG abdomen revealed mixed echogenic mass in the hepatic area. CT revealed a lesion of 29 mm × 23 mm × 25 mm in hepatic segment VI	Laparoscopic exploration revealed a round 25-mm ectopic pregnancy lesion in hepatic segment IV, followed by open resection of the ectopic foci	Patient had polycystic ovary syndrome
Yang et al[27], 2024	30s	Lumbar and abdominal pain	β-hCG: 2244 IU/mL, MRI abdomen showed a quasicircular high signal inside with a diameter of 20 mm near the right lobe of the liver close to the diaphragm	Laparoscopic removal of the blood clots and electrocoagulation of the bleeding site near segment VI and diaphragm. Final diagnosis of the patient was diaphragmatic adhesion secondary to liver ectopic pregnancy loss	History of one previous induced abortion following pregnancy achieved through assisted reproductive technique
Beck et al[26], 2024	24	Abdominal pain in RUQ	β-hCG: 3702 IU/mL, USG abdomen revealed inhomogeneous tumor measuring 9 cm × 5 cm × 4 cm, attached to the right lobe of the liver	8 weeks after methotrexate, robotic-assisted tumor resection was performed	Final histopathological examination unveiled chorionic villi in a state of severe regression confirming the diagnosis of abdominal ectopic gravidity
Yusuf et al[28], 2024	35	Severe dull pain in right hypochondrium with multiple episodes of vomiting and amenorrhea for 3 months	β-hCG: 168100 IU/mL, USG abdomen revealed a single, smoothly contoured gestational sac in the right hepatic lobe, containing a fetus with FHR+. The gestational age, based on crown-rump length, was measured at 5.75 cm, corresponding to 12 weeks	Wedge segmental resection of segment VI, Pringle maneuver and hepatic packing for hemostasis	History of previous cesarean section
Rajanbabu et al[20], 2024	33	Abdominal pain	β-hCG: 18336 IU/mL, USG abdomen showed a hyperechoic lesion with echogenic components suspicious of an ectopic pregnancy with a fetal pole but absent FHR	A small segment of the liver along with the ectopic foci were excised	2 previous cesarean sections
Manzaneda-Peralta et al[29], 2025	30	Abdominal pain and hemorrhagic shock	β-hCG: 55710 mUI/mL, USG abdomen revealed presence of rounded image with defined contours in the right hepatic lobe, containing a fetus of 13 weeks, movements+ and FHR+	Exploratory laparotomy with hepatic wedge resection and Pringle maneuver and hepatic packing for hemostasis	No history of previous pregnancy
Anant et al[30], 2025	30	Recurrent right hypochondrial pain and vomiting lasting 3 months	MRI abdomen revealed a complete 12-week fetus attached to the inferior surface of segment VI of the right lobe of the liver	Right paramedian incision, gestational sac and a well-formed fetus were identified over segment VI and were removed	1-year follow-up revealed an avascular 13-week gestational sac in the liver

β-hCG: Human chorionic gonadotropin; N/A: Not applicable; RUQ: Right upper quadrant; USG: Ultrasonography; FHR: Fetal heart rate; MRI: Magnetic resonance imaging.