A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome

Allani, Linda El; Benlamkaddem, Said; Berdaï, Mohamed Adnane; Harandou, Mustapha

doi:10.11604/pamj.2020.36.78.23302

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Hepatic infarction is often rare due to the dual blood supply of the liver [ 4 ]. Nonetheless, there have been cases described in the literature [ 5 , 6 ]. Subcapsular hematoma is a rare complication of HELLP syndrome and can rupture, leading to hemoperitoneum and shock [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Paudel¹,

Altomare²,

Shogbesan³

et al. 2022

Cureus

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Hepatic infarction is uncommon due to the dual blood supply from the hepatic artery and portal vein. The majority of the cases are caused following liver transplant or hepatobiliary surgery, hepatic artery occlusion, or shock. Hepatic infarction is a rare complication of hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. HELLP is an obstetrical emergency requiring prompt delivery. The presence of elevated liver enzymes, mainly alanine aminotransferase and aspartate aminotransferase in pre-eclampsia, should warrant diagnosis and treatment in the line of HELLP syndrome. Our patient with underlying sickle cell trait presented with features of HELLP syndrome in her third trimester of pregnancy. She underwent cesarean delivery on the same day of the presentation. The liver enzymes continued to rise following delivery and peaked on postoperative day two. Contrast computed tomography scan showed multifocal hepatic infarctions. Pre-eclampsia by itself is a state of impaired oxygenation and can lead to hepatic hypoperfusion, and appeared to be a clear contributor to the hepatic infarction in this case. However, this case also raises the question of whether the underlying sickle cell trait might have potentiated the hepatic infarction. Although sickle cell disease is well known to cause hepatic infarctions, it is unknown whether the sickle cell trait affects the liver to a similar extent as sickle cell disease. In addition, there have been case reports of sickle cell trait causing splenic infarcts and renal papillary necrosis, but it remains unclear if it can be directly associated with hepatic infarction.

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Section: Discussionmentioning

confidence: 99%

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Paudel¹,

Altomare²,

Shogbesan³

et al. 2022

Cureus

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“…Hepatic infarction can complicate a HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) and cause death in 16% of the women [40][41][42].…”

Section: Liver Infarctionmentioning

confidence: 99%

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare vascular pathology, part II

et al. 2023

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In this second part of the topic the hepatic pseudoaneurysm, hepatic infarction, and pylephlebitis are discussed as acute and potentially life-threatening hepatic vascular diseases. The focus is on their appearance on B-mode ultrasonography, duplex ultrasonography, and contrast-enhanced ultrasonography. Zahn’s pseudo infarction is an important differential diagnosis to wedge-shaped hepatic infarction in this context. Knowledge of the data should help raise awareness of these rare findings, to come up with relevant differential diagnoses in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.

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“…It can be related to preeclampsia, but in 15-20% of cases, there is no personal history of hypertension or proteinuria. Both severe preeclampsia and HELLP syndrome can determine severe hepatic lesions, such as infarction, hemorrhage, and rupture [7,43].…”

Section: Hellp Syndromementioning

confidence: 99%

State of the Art in Hepatic Dysfunction in Pregnancy

et al. 2021

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Hepatic dysfunction in pregnant women is always challenging for the obstetrician, as the spectrum of hepatic abnormalities can be very large and have various implications, both for mother and fetus. There is a diagnostic and therapeutic polymorphism of hepatic dysfunction in pregnancy and insufficient knowledge related to the etiopathogenesis and epidemiology of this disease. The clinical forms of hepatic dysfunction encountered in pregnancy can vary from liver diseases related to pregnancy (e.g., HELLP syndrome, intrahepatic cholestasis, hyperemesis gravidarum, or acute fatty liver of pregnancy) to de novo ones occurring in pregnancy, and pre-existing liver disease (cholelithiasis, Budd–Chiari syndrome, and cirrhosis). We performed a systematic literature search over 10 years. The review protocol assumed a search of two databases (PubMed®/MEDLINE and Web of Science Core Collection). The strategy regarding the management of these diseases involves multidisciplinary teams composed of different specialists (obstetricians, gastroenterologists and anesthetists) from specialized tertiary centers. Despite the improving prognosis of pregnant women with liver diseases, the risk of maternal–fetal complications remains very high. Therefore, it is necessary to ensure careful monitoring by a multidisciplinary team and to inform the patients of the potential risks.

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A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome

Cited by 12 publications

References 17 publications

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Hepatic Infarction in a Patient With Sickle Cell Trait Presenting With HELLP Syndrome

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare vascular pathology, part II

State of the Art in Hepatic Dysfunction in Pregnancy

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