Perioperative challenges following management of spontaneous hepatic rupture in a parturient with severe pre-eclampsia – A case report

Singh, Keevan; Carvalho, Randall; Tinne, Allan; Bahall, Vishal; DeBarry, Lance; Sankar, Steven

doi:10.1016/j.crwh.2023.e00499

Cited by 1 publication

(2 citation statements)

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“…In our case, hemoperitoneum was found during an emergency cesarean section, after which surgical exploration and compression by hepatic tamponade were immediately performed and bleeding was controlled. Notably, the case described by Singh et al involved five operations by laparotomy [11]. To avoid repeated laparotomies for our patient, we removed the tamponade gauze pads and performed intraperitoneal drainage.…”

Section: Discussionmentioning

confidence: 96%

“…To avoid repeated laparotomies for our patient, we removed the tamponade gauze pads and performed intraperitoneal drainage. As patients with hepatic rupture often present with coagulopathy due to potential HELLP syndrome [11], hepatic artery embolization can be used to adjunctively manage patients with persistent liver bleeding or rebleeding after surgical treatment [12,13]. However, ischemic complications associated with vascular embolization, such as liver necrosis, are not uncommon and may lead to surgical debridement or hepatic resection [14].…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary management of a pregnant woman with hepatic rupture complicated with HELLP syndrome

Ren

2024

Am J Transl Res

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A 32-year-old woman with preeclampsia who presented with persistent severe hypertension and epigastric pain underwent an emergency cesarean section for fetal distress and was diagnosed with hepatic rupture and HELLP (hemolysis, elevated liver enzymes, and a low platelet) syndrome. After the operation, the patient was transferred to the intensive care unit for supportive treatment and management of complications. Diagnosis and treatment decisions were made through multidisciplinary management. The patient received plasma exchange and continuous renal replacement therapy. One week after the operation, the patient developed deep vein thrombosis and received anticoagulant therapy, which triggered rebleeding. Conservative treatment was taken, including halving the dosage of anticoagulant medication and performing a blood transfusion, and the patient's condition gradually stabilized. The patient was discharged 44 days after the operation. Early diagnosis, effective treatment, and multidisciplinary management can help patients with this critical presentation achieve good clinical outcomes.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%