HELLP Syndrome Complicated by Subcapsular Hematoma of Liver: A Case Report and Review of the Literature (original) (raw)
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Postpartum HELLP syndrome complicated with large subcapsular liver hematoma
Baylor University Medical Center Proceedings
Subcapsular hematoma of the liver is a potentially fatal complication of pregnancy-related hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. In turn, HELLP syndrome is one of the most critical complications of preeclampsia. We present a case of a 31-year-old woman who developed a subcapsular liver hematoma in the postpartum period secondary to HELLP syndrome. The diagnosis was made based on the clinical features, radiological investigation, and laboratory values. She was managed with fluids, intravenous steroids, and rigorous monitoring in the intensive care unit before being moved to a tertiary care center with hepatic surgery and interventional radiology capabilities.
Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome
Case Reports in Hepatology
Subcapsular liver hematoma (SLH) is a rare complication of HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. We report a previously healthy 16-year-old female presenting with pre-eclampsia requiring emergent C-section, who developed immediate postoperative bleeding and abdominal distention. Abdominal computed tomography angiography (CTA) revealed a large encapsulated liver hematoma with active extravasation. The patient was successfully treated with a multidisciplinary approach with medical and surgical management.
Journal of Shahrekord University of Medical Sciences
Hepatic subcapsular hematoma is a rare but potentially life-threatening complication that is caused by preeclampsia and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, which may be manifest with nonspecific signs and symptoms. The present case was a 36-year-old woman with a secondary subcapsular liver hematoma as a rare complication of HELLP syndrome. The patient complained of nausea, vomiting, pain in the right upper quadrant of the abdomen, epigastric pain, and severe pain in the right shoulder. On the fourth day after delivery, a computed tomography (CT) scan was performed on the patient, showing a large subcapsular hematoma around the liver. Six weeks after delivery, the follow-up ultrasound exhibited no residual hematoma or free peritoneal fluid, and the patient’s blood pressure was controlled without taking medication.
European Journal of Radiology Extra, 2004
We report the case of a 40-year-old woman, who had extensive hepatic necrosis, multiple liver infarctions, subcapsular liver hematoma, acute renal failure, and massive ascites in the setting of hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP) syndrome in the post-partum period. Our purpose was to describe the effects of serious obstetric complications on maternal and perinatal outcome in pregnancies complicated by HELLP syndrome and the role of radiological findings in the diagnosis and course of the patient. We describe a patient who had abnormal sonographic findings of the liver immediately post-partum before signs and symptoms of severe preeclampsia and HELLP syndrome. The abnormal sonographic appearance of the liver prompted further investigation and was instrumental in the management of this case. These serious hepatic complications can be initially detected by ultrasonography. In addition, computed tomography of the abdomen confirmes the diagnosis and delineates the lesions more precisely. Moreover, ultrasonography can be used as a screening imaging modality compare to computed tomography and magnetic resonance imaging.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Subcapsular liver hematoma is rare complication of severe preeclampsia and HELLP syndrome, thus making it essential for these patients to be followed up in critical and intensive care units for advanced medical support with fluid and electrolyte management and replacement of blood products while treating underlying disorders. Treatment options have to be individualised and vary from conservative management to surgical treatment including hepatic resection, hepatic artery ligation, and liver transplantation. In this paper we report a case of ruptured hepatic hematoma in a 35 year old female, few hours within delivery, a complication of severe preeclampsia and HELLP syndrome
Keywords: Mortality HELLP syndrome Antepartum eclamptic fit Ruptured subcapsular liver hematoma Abdominal packing and B-lunch suture a b s t r a c t Objective: To describe a fatal case of ruptured subcapsular liver hematoma as regards diagnoses and management. Design: Case report. Setting: Department of Obstetrics and Gynecology. Patient: A 25-year-old woman developed HELLP syndrome and antepartum eclamptic fit complicated with ruptured subcapsular liver hematoma during the 28th week of pregnancy. Intervention: Midline abdominal exploratory laparotomy, with delivery by caesarean section. Tight abdominal packing for the hematoma and Pringle maneuver were done. Partial couvelaire uterus was managed by prostaglandins and B-Lynch brace sutures to minimize uterine bleeding and atony. The patient developed postoperative hepatic, renal failure, coagulopathy, deterioration and finally death.
Cureus, 2022
HELLP syndrome is an acronym used, since 1982, to describe a combined disorder of the liver and coagulation cascade defined as pre-eclampsia in pregnant women with hemolytic anemia, an increase in liver enzymes, and a decrease in platelet count. Spontaneous liver rupture is an exceptionally rare and extremely severe, occasionally lethal, complication of pre-eclampsia-eclampsia and especially hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. The following report describes a case of a 48-yearold woman diagnosed with HELLP syndrome complicated by spontaneous liver rupture who was treated conservatively.
The American Journal of the Medical Sciences, 2002
HELLP syndrome (hemolysis, elevation of liver enzymes, and low platelet count) occurs during pregnancy. Intrahepatic hemorrhage and subcapsular liver hematoma with or without rupture are reported complications of this syndrome. The patient described in this report developed HELLP syndrome associated with a subcapsular liver hematoma and pulmonary artery thrombus, complications that created a therapeutic conundrum.
Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome
Archives of Gynecology and Obstetrics, 2009
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 × 103/mm3. 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/µL. 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.
[Subcapsular hematoma of the liver complicating preeclampsia: about 6 cases]
The Pan African medical journal, 2011
L'hématome sous capsulaire du foie (HSCF) est une complication rare mais gravissime de la grossesse. Devant une symptomatologie clinique souvent non spécifique et un tableau biologique retardé, son diagnostic est basé essentiellement sur les moyens de l'imagerie (échographie, TDM, IRM). Son traitement est fonction de l'intégrité ou non de la capsule de Glisson. Nous rapportons les observations de 6 patientes, à travers une étude rétrospective s'étalant sur la période du Janvier 2005 à Octobre 2008, incluant tous les cas de preeclampsie colligés au service de gynécologie obstétrique du CHU Hassan II. Durant la période d'étude, L'incidence de l'hématome sous capsulaire de foie chez les patientes préeclamptiques admises durant la période d'étude est de 1,49 %. Aucune des patientes n'a benificié d'un suivi prénatal au sein de notre formation. La moyenne d'âge des patientes est de 37,6 ans avec des extrêmes allant de 33 à 45 ans. La gestité moyenne était de 4,8 avec une parité moyenne de 4,5.l'hematome sous capsulaire est survenu en post partum chez tous nos cas avec un délai moyen de 4 jours et des extrêmes allant de J0 et J10 du post partum .Toutes les patientes ont présenté un HELLP syndrome concomitant à la survenue de cette complication gravissime.Le diagnostic positif s'est basé sur les données échographiques dans 5 cas (hemoperitoine -HSCF).l'équipe a opté pour une abstention thérapeutique avec surveillance armée chez 2 cas et l'exploration chirurgicale a été indiquée chez quatre patientes en instabilité hemodynamique.Nous avons déploré deux cas de décès maternel.