Ruptured Hepatic Adenoma Associated With an Ectopic Pregnancy

Abstract

Introduction: Hepatic adenomas are benign epithelial liver tumors that uncommonly occur in otherwise normal liver. They occur more commonly in childbearing women and are mostly associated with contraceptive use. We present a case of rupture hepatic adenoma associated with an ectopic pregnancy. Report of a case: A 34-year-old Caucasian female with no significant past medical history presented initially to the hospital with right lower quadrant (RLQ) pain. Her initial evaluation with pelvic ultrasound revealed evidence of ruptured right ectopic pregnancy for which she underwent laparoscopic total salpingectomy. Post discharge she continued to have severe RLQ pain however radiating to right shoulder. Laboratory data revealed mildly elevated liver transaminases (AST 81 U/L, ALT 69 U/L, ALP 63 U/L) with normal platelets ( 209x 10 (9)/L) and normal serum glucose (110 mg/dL). She had no evidence of preeclampsia and her vital signs were stable. A Computed Tomography (CT) of the abdomen and pelvis was obtained for further evaluation which revealed a large hepatic hematoma in the right lobe of the liver secondary to ruptured hepatic adenoma (Figure 1). She was managed conservatively and discharged thereafter with no need for percutaneous drainage. Follow-up Magnetic Resonance Imaging (MRI) of the abdomen revealed evidence of small other hepatic adenomas in the right and left lobes of the liver along with decrease in the size of previously diagnosed subcapsular hematoma (Figure 2). She was followed up in the clinic where the discussion of future pregnancy was done. She was informed that monitoring of the size of hepatic adenomas during future pregnancy may be warranted.Figure 1Figure 2Discussion: Several cases of ruptured hepatic adenoma during gestation have been described in literature. The association may be related to the increase in endogenous levels of steroid hormones. Prognosis may vary from a benign course to maternal and/or fetal mortality. Mortality may be related to delay in diagnosis due to low suspicion or confusing clinical picture. Conclusion: Ruptured hepatic adenoma in the setting of ectopic pregnancy is a rare association. Healthcare providers may need to be aware of this rare coincidental entity and include it in the differential diagnosis of abdominal pain in child-bearing women.