Postpartum Spontaneous Subcapsular Hepatic Hematoma Related to Preeclampsia

Abstract

Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency department of our institution complaining of severe epigastric pain. Diagnostic work-up was suggestive of a subcapsular right lob hepatic hematoma which was successfully managed conservatively. Timely diagnosis is necessary for the prevention of life-threatening events in mother and fetus. For this reason acute care physicians have to be vigilant of the condition and consider this in the differential diagnosis of epigastric pain during pregnancy and postpartum.

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

“…To our knowledge, there have been two prior cases reported similar to ours. Anyfantakis et al report a case of a 32-year-old primiparous female developing preeclampsia and fetal distress requiring an emergent caesarian delivery [6]. Following delivery, the patient experienced acute hemolysis and mildly elevated liver enzymes without thrombocytopenia, with an associated subcapsular hematoma of the right hepatic lobe observed on abdominal CT. Luhning reports a more complicated case of a 40-year-old female who was also diagnosed with preeclampsia at 39 weeks' gestation requiring a cesarean delivery [5].…”

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

“…Treatment for patients who are hemodynamically stable with capsule integrity is mostly conservative. 15 …”

“…Treatment for patients who are hemodynamically stable with capsule integrity is mostly conservative. 15 Hemodynamically unstable patients should be immediately given fluid and blood resuscitation, and surgical treatment. [16][17][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.…”

Spontaneous Subcapsular Hepatic Haematoma: A Rare Case Report

“…First described in 1844, SHH involves the spontaneous collection of blood between the capsule of Glisson and the liver parenchyma. 1,3,4 Axial (A) and coronal (B) views, showing a large subcapsular haematoma. A B…”

“…[1][2][3] Presenting clinical signs are not specific, but can include right upper quadrant (RUQ) or epigastric pain, severe shoulder pain, nausea, vomiting, shortness of breath, abdominal distention, and hypovolaemic shock. 3,4 Diagnosis can be delayed due to rarity and variability of presentation but is made by imaging, ultrasound, CT, or MRI. Management is either conservative or surgical.…”