Grade III subcapsular liver hematoma secondary to HELLP syndrome: A case report of conservative management

Bradke, Daniel; Tran, Ashley; Ambarus, T; Nazir, Munir; Markowski, Maryann; Juusela, Alexander

doi:10.1016/j.crwh.2019.e00169

Cited by 17 publications

(22 citation statements)

References 13 publications

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“…Care must be taken with such patient presentation, as to not misdiagnose it as another intra-abdominal pathology or even pulmonary embolism [2]. Known patient history of preeclampsia should help in guidance toward a prompt diagnosis of potential complications, such as HELLP, and the sequelae which may present [10]. In the laboratory, in addition to the sudden drop in hematocrit, there is a large increase in transaminases (>1,000 IU/L), a drop in platelets and disturbances of coagulation factors.…”

Section: Discussionmentioning

confidence: 99%

Subcapsular Liver Hematoma: A Rare Complication of Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome Managed Conservatively

Grigorakis¹,

Tzimas²,

Alexakis³

et al. 2022

Cureus

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HELLP syndrome is an acronym used, since 1982, to describe a combined disorder of the liver and coagulation cascade defined as pre-eclampsia in pregnant women with hemolytic anemia, an increase in liver enzymes, and a decrease in platelet count. Spontaneous liver rupture is an exceptionally rare and extremely severe, occasionally lethal, complication of pre-eclampsia -eclampsia and especially hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. The following report describes a case of a 48-yearold woman diagnosed with HELLP syndrome complicated by spontaneous liver rupture who was treated conservatively.

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Section: Discussionmentioning

confidence: 99%

Subcapsular Liver Hematoma: A Rare Complication of Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome Managed Conservatively

Grigorakis¹,

Tzimas²,

Alexakis³

et al. 2022

Cureus

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“…Nonetheless, there have been cases described in the literature [ 5 , 6 ]. Subcapsular hematoma is a rare complication of HELLP syndrome and can rupture, leading to hemoperitoneum and shock [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Paudel¹,

Altomare²,

Shogbesan³

et al. 2022

Cureus

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Hepatic infarction is uncommon due to the dual blood supply from the hepatic artery and portal vein. The majority of the cases are caused following liver transplant or hepatobiliary surgery, hepatic artery occlusion, or shock. Hepatic infarction is a rare complication of hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. HELLP is an obstetrical emergency requiring prompt delivery. The presence of elevated liver enzymes, mainly alanine aminotransferase and aspartate aminotransferase in pre-eclampsia, should warrant diagnosis and treatment in the line of HELLP syndrome. Our patient with underlying sickle cell trait presented with features of HELLP syndrome in her third trimester of pregnancy. She underwent cesarean delivery on the same day of the presentation. The liver enzymes continued to rise following delivery and peaked on postoperative day two. Contrast computed tomography scan showed multifocal hepatic infarctions. Pre-eclampsia by itself is a state of impaired oxygenation and can lead to hepatic hypoperfusion, and appeared to be a clear contributor to the hepatic infarction in this case. However, this case also raises the question of whether the underlying sickle cell trait might have potentiated the hepatic infarction. Although sickle cell disease is well known to cause hepatic infarctions, it is unknown whether the sickle cell trait affects the liver to a similar extent as sickle cell disease. In addition, there have been case reports of sickle cell trait causing splenic infarcts and renal papillary necrosis, but it remains unclear if it can be directly associated with hepatic infarction.

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“…HA ligation, resection, and reconstruction can also be performed in HA aneurysm, pseudoaneurysm, abdominal aortic dissections, and HELLP syndrome[ 1 , 2 , 37 , 38 ]. In a meta-analysis including 374 hilar cholangiocarcinoma cases with HA resections performed by Chen et al [ 39 ], they found that the rate of R0 resection was higher in those who had HA resection.…”

Section: Discussionmentioning

confidence: 99%

Dealing with hepatic artery traumas: A clinical literature review

Dılek¹,

Atay²

2021

WJCC

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BACKGROUND The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood. AIM To reveal the evolution and recent developments in the management of HA traumas in the light of the literature. METHODS In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled. RESULTS The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature. CONCLUSION In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

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Grade III subcapsular liver hematoma secondary to HELLP syndrome: A case report of conservative management

Cited by 17 publications

References 13 publications

Subcapsular Liver Hematoma: A Rare Complication of Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome Managed Conservatively

Subcapsular Liver Hematoma: A Rare Complication of Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome Managed Conservatively

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Dealing with hepatic artery traumas: A clinical literature review

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