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

Background: Primary hepatic ectopic pregnancy is an exceptionally rare subtype of abdominal ectopic pregnancy and carries a very high risk of catastrophic hemorrhage. Due to its atypical clinical presentation and unusual implantation site, diagnosis is often delayed, leading to significant maternal morbidity and mortality. Case summary: A woman of reproductive age presented with acute upper abdominal pain and hemorrhagic shock. Pregnancy testing was positive, and transabdominal ultrasonography revealed massive hemoperitoneum with the absence of intrauterine gestation. Focused abdominal ultrasound demonstrated a heterogeneous lesion arising from the right hepatic lobe, suspicious for ruptured intrahepatic ectopic pregnancy. Initially, a diagnostic laparoscopy was performed but due to hypotension and anesthetist advice, emergency exploratory laparotomy was performed, and a ruptured intrahepatic gestational mass was identified. Complete surgical excision with hemostasis was achieved. Histopathology confirmed intrahepatic ectopic pregnancy. The postoperative course was uneventful. Conclusion: Prompt recognition, appropriate imaging sequence, and emergency surgical intervention are essential to prevent maternal mortality in hepatic ectopic pregnancy.