Primary hepatic pregnancy

A 25-year-old G2P1L1 woman with 18-week pregnancy presented with right hypochondriac pain and vomiting for the past 1 week. She had borderline vitals and a diffusely tender abdomen. Ultrasound revealed a live 18-week fetus attached to the undersurface of the liver with moderate ascites. Laparotomy was carried out which revealed 500 cc of hemoperitoneum with a primary hepatic pregnancy of the right lobe of liver and bleeding from the placental site. After extracting the fetus, the placenta was left inn situ and the abdomen was packed to control the bleeding as other hemostatic measures failed. Hepatic artery embolization was done after surgery followed by relaparotomy but the abdomen had to be repacked again as the patient was unstable with uncontrollable bleeding. The patient succumbed to DIC despite adequate replacement. In retrospect, the authors conclude that embolization could have been done before surgery and partial hepatic resection attempted in the first instance.