A 21-year-old girl is pregnant with a liver doctor: it's my first time, too.

"have you ever heard of ectopic pregnancy moving to the liver? Today is the first time I have met! " Not long ago, Chief physician Wang Yuedong, director of laparoscopic surgery at a hospital in Zhejiang, posted such a Wechat message on moments: a 21-year-old girl underwent emergency surgery because of bleeding from an ectopic pregnancy. The doctor searched the pelvis but could not find embryonic tissue. Unexpectedly, this "missing" embryo was implanted on the liver!

During the operation, there were no embryos in the pelvis.

Finally found it in the liver.

A week ago, Chief physician Wang Yuedong suddenly received a call for help from the director of surgery in a grass-roots hospital. They were operating on a patient with ectopic pregnancy in a special condition and encountered a very thorny problem.

The girl who had an ectopic pregnancy was only 21 years old, surnamed Jiang, and worked for a company in the west of the city. At that time, I went to this grass-roots hospital because of sudden abdominal pain.

The doctor asked about the medical history, Xiao Jiang was menopausal for more than 40 days, and then the examination found that she had fluid in her uterine cavity and abdominal cavity, and blood tests found that the HCG (human chorionic gonadotropin) index was elevated, which is an important basis for early pregnancy diagnosis. According to the results of these two examinations, the doctor judged that Xiao Jiang had a massive hemorrhage in her ectopic pregnancy, which was very dangerous, and immediately arranged an operation for her.

Ectopic pregnancy, also known as "ectopic pregnancy", refers to the implantation and development of the embryo outside the uterus, the most common site is in the fallopian tube. With the gradual growth of the embryo, it will lead to rupture and bleeding of the fallopian tube, which may cause hemorrhagic shock and even life-threatening if not detected and treated in time. It was precisely because of the symptoms of abdominal pain caused by bleeding in ectopic pregnancy that Xiao Jiang went to the hospital and found it.

During the operation, the doctor cleaned up the bleeding in Xiao Jiang's pelvic cavity and found that her fallopian tubes on both sides were intact and searched the entire pelvic cavity, but no embryonic tissue could be found. Oddly enough, there are a lot of fresh blood clots in the upper right of the abdominal cavity near the liver, which means that the bleeding may be in the right upper abdomen.

In an emergency, the director of surgery of the hospital dialed the number of chief physician Wang Yuedong and invited him to consult. At that time, Dr. Wang was driving home and rushed to the consultation immediately after receiving the call. He arrived in about 10 minutes. Director Wang explored Xiao Jiang's abdominal cavity through laparoscopy and finally found foreign body tissue on the lower edge of the right liver, where the bleeding was.

Under laparoscopy, Chief physician Wang Yuedong removed the foreign body tissue for Xiao Chiang, which was nothing but an embryo that had not been found for a long time before.

The probability of liver pregnancy is not high.

Once it happens, it is more dangerous than ordinary ectopic pregnancy.

"embryos like Xiao Jiang run from the pelvis to the abdominal cavity, which is called 'primary abdominal pregnancy', which is rare in clinic. This is the first time I have ever met someone who has been a doctor for so many years. "

Chief physician Wang Yuedong said that ectopic pregnancy in abdominal organs is the rarest and most dangerous type of abdominal pregnancy. Up to now, there are less than 50 cases of primary abdominal organ ectopic pregnancy reported in the literature at home and abroad, including 22 cases of liver pregnancy and 18 cases of spleen pregnancy. Less than 33% of the patients have more than 3 months of pregnancy. Most of them are diagnosed and treated due to abdominal bleeding caused by abortion or rupture in the early pregnancy. In China, only one case of laparoscopic surgery for hepatic pregnancy has been reported.

Why does the embryo run from the pelvic cavity to the abdominal cavity and be implanted in the liver?

Chief physician Wang Yuedong said that the reason is not yet clear, and scholars in the industry consider that it may be due to the reverse peristalsis of the fallopian tube, the fertilized egg is discharged into the abdominal cavity, and before it is absorbed by the peritoneum, the embryo is moved up due to the clockwise effect of intestinal peristalsis, which is just planted on the surface of the liver, spleen and other organs. On the other hand, the liver, spleen and other organs have rich blood circulation, low surface tension, and rich blood from the gastrointestinal portal vein, which is beneficial to the growth of embryos. However, with the development and growth of embryos, organ rupture may occur to form rapid massive bleeding. If the rescue is not timely, it is easy to cause hemorrhagic shock or even death. The risk of death is much greater than that of an ordinary ectopic pregnancy.

For Xiao Chiang, although the accident of the liver pregnancy was very dangerous, it finally turned the corner because of timely treatment. Fortunately, although an ectopic pregnancy occurred, her fallopian tubes were still intact and would not affect her marriage and childbirth in the future.