A routine pregnancy ultrasound test at the Rabin Medical Center shocked doctors after they discovered the patient’s gestational sac was located in her liver. The Health Ministry, as well as senior experts in the field, believe this is the first such case recorded in Israel.
More stories:
Due to the danger to the woman’s life, the pregnancy was terminated within 48 hours. The abortion was performed using Da Vinci robotic surgery, making it the first robotic surgery in the world for the removal of an ectopic pregnancy in the liver.
"The diagnostic challenge in this was the main issue because we knew the woman was pregnant and that the fetus was alive and growing, yet we couldn't locate its position in several tests," said Dr. Gadi Sabach, deputy director of the Rabin Medical Center’s Women’s Health Department. "I’m the most experienced doctor in the department, and I was trembling with excitement. Even after 30 years, there are diagnoses I haven't heard of."
Sabach said he had never heard of a pregnancy taking root in the liver. "Among the existing publications in medical literature, there is no publication about pregnancy in the liver in Israel. In my 30 years of work, I haven’t seen or heard from colleagues about a pregnancy that occurred inside the liver. Of the ectopic pregnancies, the vast majority occur in the fallopian tubes and sometimes in the ovary or the cervix of the uterus," he explained.
“The rarer cases are abdominal pregnancies. Most abdominal pregnancies settle either on the peritoneum or on tissues that supply blood to the intestines. These are the common sites of abdominal pregnancies, which are themselves very rare. A minority of intra-abdominal pregnancies occur in the liver," he added.
After no less than four ultrasound tests, doctors couldn’t find the developing fetus. Only a CT scan revealed a suspicious finding in the woman's liver, which was confirmed later as an eight-week-old fetus.
"There is no risk group for such a pregnancy, but the only explanation for this is that the liver is a richly vascularized organ, and that is what is required to allow pregnancy to develop in an abnormal location," according to Sabach.
"This is an extremely rare case," added Professor Eran Sadot, director of Hepatobiliary and Pancreatic Surgery at Rabin Medical Center. "There are 20 similar cases recorded in the professional literature worldwide over the years.”
“The danger in this situation is that if the pregnancy grows in an unprotected area and if a fetus is growing inside the liver, it may rupture it, which could lead to death. When an egg is released from the ovary and moves toward the uterus, this transition passes through an organ called the fallopian tube, which isn’t completely hermetic," he explained.
“Therefore, rarely, the sperm reaches this junction area and an actual pregnancy occurs there, which regresses and moves backward. It doesn't continue in the usual direction toward the uterus but rather moves into the abdominal cavity. In most cases of ectopic pregnancies, it lodges somewhere in the pelvis," Sadot said.
“In the patient’s case, the ectopic pregnancy somehow migrated to the upper abdomen and implanted itself within the liver. The woman was being monitored for her pregnancy at her local health maintenance organization,” he explained.
“The doctor followed the pregnancy, and in the eighth week of pregnancy, she discovered that blood tests noted an advanced pregnancy, but ultrasound tests didn’t show the pregnancy in the abdomen. She was then referred to us, and that's when the process began, culminating, as mentioned, in the rare diagnosis.”
The patients life could have been in danger, according to the doctor. "There can be no hesitation in such a diagnosis. In any case of an ectopic pregnancy, there is an immediate life-threatening danger to the woman due to bleeding. In the liver, this danger is significantly greater because it has many blood vessels. It is an organ with a complex network of large blood vessels, and nephrotic bleeding means immediate life-threatening danger,” he said.
“The woman will be able to conceive again. The large incisions that were once made during the surgery caused scars in the abdomen that could prevent conception. Aborting the pregnancy via a robot, which is much more precise, will enable her to conceive in the future. This is the first robotic surgery ever recorded in the world for the removal of an ectopic pregnancy in the liver," Sadot said.