Rarest-of rare liver pregnancy successfully treated at Goa Medical College
The patient was successfully operated and haemostasis was prevented. She was discharged on the 13th day post operation.
Doctors at the Goa Medical College and hospital were able to save the life of a 25-year-old woman who was diagnosed with a rarest of rare cases of intrahepatic pregnancy -- in which a live eight week old embryo was found growing in the patient’s liver -- threatening to cause severe haemorrhage that could have claimed her life.
The patient was rushed to the hospital with severe abdominal pain and vomiting and was initially diagnosed with some ‘lump’ in the liver and was referred to the radiology department.
“Dr Shika Lawande and Dr Glory, both residents in the department of radiology did the preliminary ultrasound and were astonished to see a live two and a half months pregnancy in the right lobe of the liver with blood in the peritoneal cavity,” the dean of Goa Medical College, Dr Shivanand Bandekar told reporters.
“The pregnancy was inside the liver -- some of it was inside and some outside. So when the patient was scanned, the resident found the embryonic sac with a developing foetus within with a beating heart -- it was a live ectopic pregnancy within the liver. We then did more tests to confirm because it is one of the rarest things -- those investigations also confirmed that it is an intrahepatic ectopic pregnancy,” Dr Jeevan Vernekar, the head of the radiology department, said.
The patient was sent for an emergency surgery.
“We had to excise (extract) that whole mass along with part of the liver. It was successfully done and haemostasis was prevented. This patient was discharged on the 13th day post operation,” Dr Francis Noronha, who heads the general surgery department, said.
“It was intrahepatic and bleeding, which is why the patient was not in a good state. We removed this along with that section of the liver,” Dr Dattaprasad Samant, who performed the operation along with the team, added.
According to Dr Guruprasad Pednekar, intrahepatic pregnancies are so rare that globally only 41 cases have been recorded, while in India only two cases -- one in 1982 in Lucknow in which both the mother and the baby survived and the second in Delhi in 2012 in which the patient could not be saved.
“When this pregnancy grows, it derives its blood supply from the liver and the liver is a very vascular organ and if we allow this pregnancy to continue, subsequently there will be tremendous haemorrhage -- bleeding from the liver -- which can cost the patient her life,” Dr Pednekar said.
The woman, the mother of two young children, was encountering her sixth pregnancy having undergone three abortions till date.
“There is no definite cause known -- they are postulating different theories -- one of the theories is that the fertilized embryo goes by the peritoneal fluid current and settles on the nearest available vascular supply that is the liver. For a pregnancy to survive, it has to get blood supply from some source; these are rich organs of blood supply,” Dr Pednekar said.