Year 2023 / Volume 115 / Number 8
Letter
Ruptured subcapsular liver hematoma as a rare complication of HELLP syndrome. A therapeutic challenge

465-466

DOI: 10.17235/reed.2022.9276/2022

Luis Alejandro García González, Raquel Rodríguez Uría, Pablo Noriega Menendez, Lorena Solar Garcia, Alberto Miyar de León, Ignacio María González-Pinto Arrillaga, José Electo Granero Trancón,

Abstract
HELLP syndrome (HS), a low-incidence condition of uncertain pathogenesis associated with pregnancy hypertensive syndromes, is characterized by hemolysis, elevated liver enzymes and low platelet count. Ruptured subcapsular liver hematoma complicated with hemoperitoneum is an uncommon but very serious condition where early recognition and multidisciplinary management are key to reduce its associated maternal, infant mortality rate. Symptoms are nonspecific, characterized by por epigastric pain, nausea and vomiting; clinical suspicion and appropriate imaging studies are of crucial importance. We report the case of a 36-year-old primiparous woman at 39 weeks of gestation. She was admitted for early membrane rupture, with delivery complicated by retained placenta. During the immediate puerperium she had blood pressure > 140/90 mmHg, epigastric pain and vomiting, which required respiratory and hemodynamic support. An exploratory laparotomy was performed that revealed a massive hemoperitoneum as well as CR in the RLL with multifocal active bleeding. The left liver lobe was macroscopically normal. The patient underwent hemoperitoneum drainage and hepatic packing (HP); biopsy findings were consistent with necrosis. Polytransfusion was initiated with blood products and antihemorrhagic agents.
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References
1. Mazzola A, Magro B, Perdigao F, Charlotte F, Atif M, Goumard C, et al. Acute liver failure and HELLP syndrome: A clinical case and literature review. Clinics and Research in Hepatology and Gastroenterology. 2021;45(2).
2. Rath W, Tsikouras P, Stelzl P. HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge. Geburtshilfe Frauenheilkd. 2020;80(5):499–507.
3. Marsh FA, Kaufmann SJ, Bhabra K. Surviving hepatic rupture in pregnancy - A literature review with an illustrative case report. Journal of Obstetrics and Gynaecology. 2003;23(2):109–13.
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Citation tools
García González L, Rodríguez Uría R, Noriega Menendez P, Solar Garcia L, Miyar de León A, González-Pinto Arrillaga I, et all. Ruptured subcapsular liver hematoma as a rare complication of HELLP syndrome. A therapeutic challenge. 9276/2022


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Publication history

Received: 11/10/2022

Accepted: 19/10/2022

Online First: 25/11/2022

Published: 26/07/2023

Article Online First time: 45 days

Article editing time: 288 days


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