Hemorrhagic Shock in Primary Hepatic Pregnancy: A Diagnostic and Surgical Challenge.

Abstract

Introduction: Primary hepatic ectopic pregnancy is rare; it has been reported to have an incidence of 1:15,000 per uterine pregnancy approximately. This study aims to determine the clinical presentation and treatment of hepatic ectopic pregnancy. Presentation of Case: We present the case of a patient with no history of pregnancy who presented with abdominal pain refractory to treatment. With a human chorionic gonadotropin hormone (β-hCG) measure of 55,710 mIU/mL, an abdominal ultrasound that revealed the presence of a rounded image of 50 mm × 50 mm at the level of the right hepatic lobe and the complication of hypovolemic shock. Under the diagnosis of an abdominal ectopic pregnancy, the patient underwent surgery. Discussion: Initially, an exploratory laparotomy was performed, which revealed the presence of bleeding, clots, and a gestational sac; subsequently, a wedge resection was done, and a Pringle maneuver and hepatic packing were performed, obtaining favorable results in the patient's case. Conclusion: The diagnosis of primary hepatic ectopic pregnancy is made through β-hCG measurement and serial abdominal ultrasonography. Treatment can be pharmacological (methotrexate) or surgical, applying techniques such as the Pringle maneuver.