Simultaneous Tubal and Intrahepatic Ectopic Pregnancy Managed by Feticide and Conservative Observation

Background Hepatic ectopic pregnancy (HEP) is a rare and life-threatening condition, with only approximately 40 cases previously reported worldwide. We present the first documented case of a patient presenting with an acutely ruptured tubal ectopic pregnancy who was subsequently diagnosed with a separate, viable intrahepatic pregnancy. Case Presentation A 38-year-old woman (Para 6) presented in hypovolemic shock (BP 90/40 mmHg) due to a ruptured right tubal ectopic pregnancy, requiring emergency laparotomy and salpingectomy. Eleven days later, she returned with epigastric pain. A subsequent liver scan surprisingly revealed a separate, viable intrahepatic pregnancy located in liver segment 7. Given the extremely high risk of catastrophic hemorrhage associated with a solid organ gestation, a Multidisciplinary Team (MDT) recommended termination. Ultrasound-guided feticide was performed using an intracardiac injection of 20% sodium chloride solution, which successfully achieved fetal asystole. The patient remains stable and is under conservative, antibiotic-supported expectant management. Conclusions This case highlights the critical need to maintain a high index of suspicion for secondary or persistent abdominal gestation in patients presenting with new or unresolved pain shortly after initial ectopic pregnancy management. For deeply embedded, high-risk solid-organ ectopics, local feticide followed by conservative observation offers a safer definitive treatment pathway compared to potentially high-mortality surgical excision.