A rare medical case in Israel: A pregnancy developed in the liver of a 40-year-old woman

An exceptionally rare medical case was documented last week at the Wolfson Medical Center, when a 40-year-old woman from Holon was diagnosed with an ectopic pregnancy that developed in the liver, one of the rarest conditions in gynecology. According to a review of medical literature conducted by the team that treated her, this is one of only 47 cases documented worldwide in more than six decades.

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus. In the vast majority of cases, the pregnancy develops in one of the fallopian tubes, but in this case, the pregnancy implanted in the liver, an organ rich in blood vessels. This is a condition that does not allow the pregnancy to continue and can cause life-threatening internal bleeding if not diagnosed in time. According to the report, the patient, a mother of two, did not even know she was pregnant. She turned to the hospital after suffering from severe abdominal pain, a feeling of weakness, and shortness of breath, even though she said she had a period about two weeks earlier and therefore did not suspect she was pregnant.

Blood tests showed high levels of the pregnancy hormone, but an ultrasound showed the uterus was empty. Only after additional tests was the medical team able to locate the gestational sac, containing an embryo with a heartbeat at the seventh week, attached to the liver.

The patient described that receiving the diagnosis was particularly shocking and that she feared for her life and the fate of her children after realizing how dangerous the medical condition was.

"In more than 95% of cases, the pregnancy develops in the fallopian tube"

According to Prof. Ron Sagiv, director of the Advanced Gynecology Unit at the Wolfson Medical Center, this is one of the rarest cases he has encountered in more than 30 years of his work. According to him, an ectopic pregnancy occurs in about 1%-2% of all pregnancies, but in more than 95% of cases, it develops in the fallopian tube. A pregnancy that developed in the liver is extremely rare.

How did the pregnancy reach the liver?

It is estimated that the egg was fertilized in the fallopian tube, but instead of moving to the uterus, it went out into the abdominal cavity, migrated, and implanted in the liver. Despite the possible explanation, the doctors admit that it is still unclear why in such rare cases a fertilized egg manages to implant specifically in organs like the liver, spleen, or the wall of the abdominal cavity.

Rapid diagnosis – and a life-saving surgery

The medical team initially suspected a regular ectopic pregnancy but continued the investigation after no pregnancy was found in the uterus. Using an ultrasound of the upper abdomen, the gestational sac was identified in the liver – a diagnosis that led to an urgent surgery performed using a minimally invasive laparoscopic approach. During the surgery, the gestational sac was removed along with a small part of the liver tissue to which it was attached, while stopping the bleeding and preserving the rest of the liver tissue. According to the doctors, unlike many of the cases described in medical literature where an open surgery was performed, in this case, it was possible to perform the procedure using a minimally invasive approach, which allowed for a faster recovery.

Message to women: "Do not ignore unusual pain"

After recovering from the surgery, Michal asked to convey a message to other women: "Do not be heroes and do not think you know everything. If there is unusual pain or a feeling that something is wrong, go get checked. It can save lives."