Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome (original) (raw)
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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.
Case reports in obstetrics and gynecology, 2014
Subcapsular liver hematoma (SLH) is a rare complication of severe preeclampsia and HELLP syndrome. These patients must be followed up in intensive care unit for advanced medical support with infused fluid, replacement of blood products, and treatment of underlying disorders. There are a lot of therapeutic options varying from conservative management to surgical treatment including hepatic resection, hepatic artery ligation, and liver transplantation. In this report we aimed to present a 26-year-old woman with SLH secondary to HELLP syndrome.
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.
Taiwanese Journal of Obstetrics and Gynecology, 2010
Spontaneous subcapsular liver hemorrhage with or without rupture is an uncommon but potentially lethal complication of pregnancy . It is often associated with severe preeclampsia or the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome . The maternal mortality rate is very high when hepatic rupture occurs, varying from 18% to 86% . Early evaluation with imaging, appropriate diagnosis and prompt management are very important. Improved survival can be achieved through prompt recognition and a multidisciplinary approach [1]. To date, most cases have been managed with an aggressive operative approach, but surgery might not always be necessary if the patient is closely monitored . We present a case of spontaneous rupture of subcapsular liver hematoma in association with HELLP syndrome, and the patient was successfully treated after surgical packing at laparotomy.
Case Reports in Women's Health, 2020
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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
Spontaneous liver hematoma and a hepatic rupture in HELLP syndrome: report of two cases
Surgery today, 2002
In addition to more common gestotic symptoms, such as edema, proteinuria, and hypertension, the clinical picture is characterized by microangiopathic hemolysis, thrombocytopenia and, especially, impaired hepatic function. Within this clinical picture severe complications can occur, such as eclamptic attacks, renal dysfunction, intracranial hemorrhage, intrahepatic hemorrhage, and coagulopathy. The HELLP syndrome (HS) may cause subcapsular liver hematomas. When a hepatic rupture occurs, the mortality of mother and unborn is high. A spontaneous rupture of a subcapsular liver hematoma in pregnancy is a rare and potentially life-threatening complication of preeclampsia. The incidence is approximately 1 in 45 000 live births. A liver hematoma is often not suspected until it ruptures. 2-6 We present our experience with two cases of a spontaneous rupture of subcapsular liver hematoma occurring in association with the HS and review the literature on this subject.
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.
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.
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.