Friday, May 2, 2008

It's in the liver, baby

For those of you who think that your liver's only function is to detoxify your body after a night at the saloon, check out this story:

In May 2003, a South African woman carried a healthy baby girl to term on and in her liver. When my wife Angela brought home this tale of miraculous reproduction from her anatomy class a few weeks ago, I was dubious. A healthy baby, growing in the liver? That sounded impossible. How did it get there? How could it survive? It turned out, however, that as usual my wife was right. Apparently this baby, back when it was nothing more than a fertilized egg, fell off the path to the uterus, floated through the abdomen, and implanted on the liver. It turns out that the path from ovary to uterus via the fallopian tube is not as tightly sealed as you might expect, and occasionally eggs lose their way. Normally, these eggs, without the rich blood supply of the uterus, wither and get reabsorbed. But, in this situation, and in a dozen or so other previously reported cases, the egg found a happy, well-vascularized (albeit alternative) home. The resulting pregnancy was extremely high-risk; without the protection of the muscular walls of the uterus, even minor trauma could have threatened the fetus. And, if the fetus or placenta had obstructed the blood or bile vessels of the liver, the mother's life would have been in danger. But, in this case, both mom and baby were fortunate; there were no serious complications, and the anomalous location of the baby was not discovered until a c-section was performed during labor. In a country with routine prenatal care, this miraculous liver pregnancy would almost certainly have suffered a different fate. Consider, a recent case report in the journal Obstetrics and Gynecology describing the "Diagnosis and Management of Hepatic Ectopic Pregnancy." (Obstetrics & Gynecology 2007;109:544-546) In this case, a woman with abdominal pain, a positive pregnancy test and an empty uterus on Ultrasound, went through a battery of tests and procedures until a MRI identified an 11-week ectopic pregnancy with fetal cardiac activity located in the maternal liver. This pregnancy, due to it's high risk nature, was successfully terminated with fetal injections of methotrexate and potassium chloride (under ultrasound guidance) and subsequent maternal intramuscular injection of methotrexate. I am sure there are some right-to-lifers out there who would argue that since this mother's life was not in imminent danger, the fetus should have been protected. The healthy liver baby from South Africa does give this argument some semblance of credence. Western medicine is efficient and saves lives, but its application does preclude some of nature's miraculous anomalies.

Medical Anomaly Trivia:
Which of the following are actual, reported, medical anomalies;

A) A girl born with two faces
B) A parasite twin (a fetus growing inside of another fetus)
C) A girl born with a cyclops eye
D) A boy with a true human tail
E) A true hermaphrodite with both ovarian and testicular tissue

Answers next week...