Medical management of hepatic ectopic pregnancy with systemic methotrexate, MRI and serial HCG monitoring

Abstract

Introduction: Hepatic ectopic pregnancies remain a diagnostic challenge which contributes to high morbidity. Little is known about the efficacy of medical management of hepatic ectopic pregnancies. As early pregnancy diagnosis continues to improve, more abdominal ectopic pregnancies will be identified before a complication occurs and patients may be candidates for less invasive management approaches. Case Report: A reproductive age G2P0010 presented with pleuritic RUQ pain and was ultimately diagnosed with a hepatic ectopic pregnancy. Given the location of the pregnancy and the difficulty accessing it from both an interventional radiology and surgical perspective, inpatient medical management with methotrexate was pursued. A multidisciplinary team including gynecology, interventional radiology, hepatobiliary surgery, and trauma surgery all participated in perioperative planning in case of an acute deterioration. The patient remained hemodynamically stable and exhibited an appropriate response to methotrexate therapy using the multi-dose regimen. Persistent radiographic changes were still evident in the liver six months later despite resolution of the human chorionic gonadotropic (HCG) values. Conclusion: This case represents a conservative approach to a complex diagnosis and should inform future clinicians expeditious administration of methotrexate therapy and careful consideration of interval imaging for treatment response.