21-year-old girl's pregnancy turns out to be on her liver, doctor says it's his first time encountering this
"Have you ever heard of an ectopic pregnancy migrating next to the liver? Today is the first time I've encountered one!" Not long ago, Wang Yuedong, chief physician and director of the Laparoscopic Surgery Department at a hospital in Zhejiang, posted this on WeChat Moments: a 21-year-old girl underwent emergency surgery for bleeding from an ectopic pregnancy, and the doctors searched her entire pelvic cavity without finding any embryonic tissue. Unexpectedly, this "missing" embryo had actually implanted on the liver!
During surgery, they searched the entire pelvic cavity but found no embryo
Eventually it was found at the liver
A week earlier, Chief Physician Wang Yuedong suddenly received a call for help from the surgical director of a primary-level hospital. They were operating on an ectopic pregnancy patient with a special condition and had run into a very thorny problem.
The girl with the ectopic pregnancy was only 21 years old, surnamed Jiang, and worked at a company in the west of the city. At the time, she went to this primary-level hospital because of sudden abdominal pain.
The doctors asked about her medical history. Xiao Jiang had missed her period for more than 40 days. Subsequent examinations found fluid accumulation in her uterine cavity and abdominal cavity, and blood tests showed elevated HCG (human chorionic gonadotropin), an important indicator for early pregnancy diagnosis. Based on these two test results, the doctors determined that Xiao Jiang had severe bleeding from an ectopic pregnancy, which was very dangerous, and immediately arranged surgery for her.
Ectopic pregnancy is also called "pregnancy in an abnormal location," referring to an embryo implanting and developing outside the uterus, most commonly in the fallopian tube. As the embryo gradually grows, it can cause the fallopian tube to rupture and bleed. If not detected and treated in time, it may cause hemorrhagic shock and even endanger life. Xiao Jiang went to the hospital because abdominal pain caused by ectopic pregnancy bleeding led to its discovery.
During surgery, the doctors cleaned out the accumulated blood in Xiao Jiang's pelvic cavity, and found that both of her fallopian tubes were intact. They searched the entire pelvic cavity but could not find any embryonic tissue. Strangely, in the upper right part of the abdominal cavity near the liver, there were many fresh blood clot tissues, meaning the bleeding point might be in the upper right abdomen.
The situation was urgent, and the hospital's surgical director called Chief Physician Wang Yuedong to ask him to come for a consultation. At the time, Dr. Wang was driving home. After receiving the call, he immediately rushed over for the consultation, arriving in about 10 minutes. Director Wang performed a laparoscopic exploration of Xiao Jiang's abdominal cavity and finally found abnormal tissue at the lower edge of the right liver. This was the bleeding point.
Under laparoscopy, Chief Physician Wang Yuedong removed the abnormal tissue for Xiao Jiang. This abnormal tissue was none other than the embryo that had been searched for so long without being found.
The probability of liver pregnancy is not high
Once it occurs, it is more dangerous than an ordinary ectopic pregnancy
"For an embryo to travel from the pelvic cavity to the abdominal cavity, as in Xiao Jiang's case, it is called 'primary abdominal pregnancy,' which is not commonly seen in clinical practice. In all my years of medical practice, this is still the first time I've encountered it."
Chief Physician Wang Yuedong said that ectopic pregnancy in abdominal organs is the rarest and most dangerous type of abdominal pregnancy. To date, fewer than 50 cases of primary ectopic pregnancy in abdominal organs have been reported in domestic and international literature, including 22 cases of liver pregnancy and 18 cases of spleen pregnancy. Fewer than 33% of patients had a gestational age of more than 3 months; most were diagnosed and treated in early pregnancy because of abdominal bleeding caused by miscarriage or rupture. In China, there is currently only 1 reported case of laparoscopic surgery for liver pregnancy.
Why does the embryo travel from the pelvic cavity to the abdominal cavity and implant at the liver?
Chief Physician Wang Yuedong said the cause is not yet clear. Scholars in the field consider that it may be due to reverse peristalsis of the fallopian tube, which discharges the fertilized egg into the abdominal cavity. Before it is absorbed by the peritoneum, the clockwise effect of intestinal peristalsis causes the embryo to move upward and happen to implant on the surface of organs such as the liver and spleen. The liver, spleen and other organs have rich blood circulation, relatively low surface tension, and abundant blood from the gastrointestinal portal circulation, which is conducive to embryo growth. However, as the embryo develops and grows, organ rupture may occur, causing rapid and massive bleeding. If rescue is not timely, hemorrhagic shock and even death can easily occur. The risk of death is much greater than that of an ordinary ectopic pregnancy.
For Xiao Jiang, although this accidental liver pregnancy was very dangerous, timely treatment ultimately brought her through safely. Fortunately, although an ectopic pregnancy occurred, her fallopian tubes remained intact, so it will not affect her future marriage and childbirth.