Management of Spontaneous Hepatic Rupture on Top of HELLP Syndrome: Case Report and Review of the Literature

Abstract

Introduction: We report the case of a patient with antepartum HELLP syndrome and simultaneous rupture of the right liver lobe. An emergency caesarean section was performed and the liver rupture was managed surgically via perihepatic packing. The mother and her child recovered well and were discharged 19 days after admission. Case Report: We describe a case report and review the literature. Based on our own experience and the most common clinical presentations of such patients, we were able to establish an algorithm for managing such cases. Conclusion: An association between liver rupture and HELLP syndrome is rare but was previously described in several case reports. In pregnant women with HELLP syndrome and acute onset abdominal pain, a potential spontaneous hepatic rupture should be taken into consideration.

An Interesting Case of a Large Spontaneous Sub Capsular Hematoma of Liver

“…It is usually seen in the right lobe of the liver in approximately 75% of the cases [1] as also described in our case and rupture into the peritoneal cavity has been correlated with a mortality rate of 75% as well [2]. The hematoma arises more commonly in pregnant ladies and is associated with preeclampsia and HELLP Syndrome [3,4]. Trauma to the liver has also been implicated in various cases especially blunt trauma in susceptible individuals and iatrogenic cases have been dealt with as well after endoscopic retrograde cholangiopancreatography, liver biopsy and biliary surgery.…”

Hepatic infarction in a pregnant woman with antiphospholipid syndrome and early pre-eclampsia: A case report

“…Hepatic infarction associated with toxemia of pregnancy is notable for its tendency to cause hepatic hemorrhage, which may lead to rupture of Glisson's capsule and catastrophic intraabdominal bleeding. [12] Hepatic infarction may not cause symptoms or may cause fever, epigastric or right upper quadrant pain, back or right shoulder pain, jaundice, nausea, and vomiting. A marked leukocytosis is common.…”

Conservative Management of Postpartum HELLP Syndrome and Intraparenchymal Liver Hematoma; A Case Report

“…The Tennessee Classification System outlined the diagnostic criteria for HELLP as AST (≥ 70 U/L), platelets < 100 × 109/L and hemolysis with increased LDH (> 600 U/L) [10]. Ultrasound scan is the quickest means of diagnosis, although computerized tomography is more sensitive [11]. Liver ultrasound should be performed in patients with the diagnosis of HELLP syndrome complaining of right upper quadrant, epigastric, or shoulder tip pain along with in the presence of hemodynamic instability [12].…”