Hepatic Artery Embolization for Hepatic Rupture in HELLP Syndrome

Gutovich, Jordan M.; Allan, Richard J. Van

doi:10.1016/j.jvir.2016.08.003

Cited by 14 publications

(4 citation statements)

References 4 publications

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“…The first decision point was whether to pursue endovascular or open surgical intervention. For patients with hepatic or splenic rupture from tumours, trauma or HELLP (haemolysis, elevated liver enzyme, low platelets syndrome, a combination of interventional radiology and surgical therapy is usually performed, with the choice tailored to each individual situation 8 9. In our case, our interventional radiology colleagues were available and able to quickly diagnose and address the issue.…”

Section: Discussionmentioning

confidence: 98%

Spontaneous hepatic rupture due to primary amyloidosis

et al. 2019

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Spontaneous hepatic rupture is an uncommon cause of haemorrhagic shock and very rarely happens due to amyloidosis. This report describes one such case in which a middle-aged man presented in extremis. He was managed initially with massive transfusion, interventional radiology embolisation and decompressive laparotomy for abdominal compartment syndrome. Subsequent coagulopathy was treated with activated factor VII due to deficient native activity. Serum protein electrophoresis and liver biopsy during his hospital course yielded a diagnosis of amyloidosis, which was treated palliatively with steroids and bortezomib. Despite supportive care, he died 10 days after presentation. This case illustrates the importance of considering an uncommon pathology when a patient presents with a condition in an uncommon way.

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Section: Discussionmentioning

confidence: 98%

Spontaneous hepatic rupture due to primary amyloidosis

et al. 2019

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“…Invasive radiology techniques may be considered in unstable patients. In cases of severe bleeding or hemorrhage, transarterial embolization may be used to block blood vessels supplying the bleeding site [13]. This technique can help control bleeding and prevent further complications.…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Postpartum HELLP Syndrome: A Rare Presentation of Preeclampsia-Associated Liver Disease and Hepatocellular Dysfunction

Do,

Murali,

Vora

et al. 2024

EJMED

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Background: HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe and sometimes fatal pregnancy condition characterized by hemolysis, increased liver enzymes, and low platelet count. While most cases occur before delivery, approximately 25% of cases manifest within 48 hours after delivery. One rare but life-threatening complication of HELLP syndrome is intraparenchymal liver hematoma. Case: In this report, we present two postpartum HELLP syndrome patients with diverse clinical manifestations. Case 1 involves a 30-year-old woman who presented with a significant subcapsular liver hematoma as a complication of postpartum preeclampsia-associated liver illness. Following conservative treatment, she improved significantly, and no surgical intervention was required. This type of subcapsular hematoma occurs in less than 2% of pregnancies complicated by HELLP. Case 2 describes an unusual HELLP presentation in a 38-year-old woman who was diagnosed with postpartum HELLP syndrome with acute liver injury and hepatic hemorrhage. Conclusion: These unique presentations underscore the significance of early detection and prompt treatment of postpartum HELLP syndrome, as it can significantly reduce risks to the mother’s health and improve overall outcomes.

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“… 16 – 18 However, surgical treatments, such as abdominal packing and liver lobectomy may lead to haemostatic failure, postoperative abdominal infection, liver dysfunction and secondary multiple organ failure, 19 so selective embolization of the hepatic artery or embolization of the arterial supply upstream of the haemorrhagic site are satisfactory therapies for hepatic arterial bleeding. 20 Embolization may effectively control bleeding, significantly improve the maternal survival rate and avoid additional trauma. In the present case, the mother underwent an emergency laparotomy, including removal of the haematoma and electrical coagulation of the wound, but the result was unsatisfactory, due to the possibility of intraoperative transient retraction of culprit vessels.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous hepatic haemorrhage after caesarean section in a patient with uraemia and superimposed preeclampsia: a case report

Chen

Song

et al. 2023

J Int Med Res

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Perinatal spontaneous hepatic haemorrhage is a very rare disease affecting pregnant women, particularly those on long-term dialysis, that has a high maternal and infant mortality rate. Most patients experience preeclampsia with haemolysis, elevated liver enzymes and low platelets syndrome. Here, the case of a 35-year-old multigravida patient with known chronic kidney disease and chronic hypertension with uraemia, who developed spontaneous hepatic haemorrhage after caesarean section, is described. The patient experienced sudden massive circulatory failure, but hemodynamics were temporarily stabilized after emergency surgery. Following transfer to the intensive care unit for continued treatment, her blood pressure and haemoglobin level continued to drop. Selective hepatic artery embolization was performed on day 2 after delivery, and her vital signs gradually stabilized. On day 30 after delivery, the patient was discharged in a stable condition. The newborn recovered after therapy in neonatal intensive care for 2 months. The present case suggests that, for perinatal spontaneous hepatic haemorrhage, timely and accurate diagnosis, multidisciplinary management and determining the therapeutic approach according to clinical symptoms are essential.

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Hepatic Artery Embolization for Hepatic Rupture in HELLP Syndrome

Cited by 14 publications

References 4 publications

Spontaneous hepatic rupture due to primary amyloidosis

Spontaneous hepatic rupture due to primary amyloidosis

Two Cases of Postpartum HELLP Syndrome: A Rare Presentation of Preeclampsia-Associated Liver Disease and Hepatocellular Dysfunction

Spontaneous hepatic haemorrhage after caesarean section in a patient with uraemia and superimposed preeclampsia: a case report

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