Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome

Abstract

We report the case of a 28-year-old nulliparous woman who presented at 36 weeks' gestation with preeclampsia: high blood pressure, proteinuria and edema. Serum test results were normal and platelet count was 155 x 10(3)/mm(3). After 30 h the patient initiated severe epigastric pain and vomits, and lab tests presented a slight increase in liver enzymes. The platelet count remained above 150,000/microL. Cesarean section (CS) was performed. Six hours after CS, she developed a hypovolemic shock and lab tests became increasingly abnormal (liver enzymes increased sharply and hemoglobin and platelet count decreased sharply). Abdominal ultrasound showed suggestive signs of hepatic rupture. The patient was stabilized and exploratory laparotomy was performed. Perihepatic packing was applied. The patient was discharged after 25 days of admission (15 days at the ICU) and three explorative laparotomies. This case highlights the unpredictability of this event based on the changes of liver enzyme values, LDH and platelet count. These changes only occurred when the rupture had already occurred and the patient was in hypovolemic shock.

Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features

“…On ultrasonography, capsular rupture may present as a hepatic fragment that moves within peritoneal fluid [15]. However, this direct finding has rarely been reported [15].…”

“…Hepatic rupture with hemoperitoneum in women with HELLP syndrome has received substantial attention in the literature [3][4][5][6][7][8][9][10][11][12][13][14][15]. However, less is known about other hepatic complications that have more subtle presentation and may precede more severe conditions.…”

A Case of HELLP Syndrome with Multiple Complications

“…Liver hematoma is a well-described complication among patients with HELLP syndrome and it can vary in severity from hepatic rupture requiring emergent surgery to a small hematoma that resolves spontaneously after observation only (11)(12)(13). Most hemodynamically stable patients respond successfully to conservative treatment (observation only).…”

Hepatic rupture: a rare but serious complication of HELLP syndrome

“…This is the presenting symptom in nearly 70% of the patients [6]. Hepatic rupture has been reported in gravid women as old as 48 years of age.…”