Right hepatectomy after spontaneous hepatic rupture in a patient with preeclampsia: A case report

Abstract

HighlightsSpontaneous hepatic rupture is a rare complication of preeclampsia and HELLP syndrome.It carries a high maternal and perinatal mortality.Multidisciplinary management is key to optimal outcomes.Usual management includes perihepatic packing or angioembolization but formal lobectomy may be required in special cases.

Spontaneous liver haematoma rupture associated with pre-eclampsia in a low- to middle-income country: Lessons to be learnt from maternal death assessments

“…[4,5] All patients in the current study had hypertension and proteinuria, again confirming previous reports. [4] Our report is important because in certain cases, such as patient 1 (Table 1), health professionals providing initial care did not suspect liver rupture in a setting of complaints of epigastric pain, nausea and vomiting, and abdominal pain associated with PE. In another case (patient 7), the patient presented in the third trimester with epigastric pain and mild elevations of blood pressure and was treated for gastritis.…”

“…The incidence of liver haematoma rupture varies between 1/45 000 and 1/225 000 pregnancies, but carries significant maternal and fetal mortality and morbidity. [1][2][3][4] Maternal mortality is high, ranging from 17% to 59%, and depends on whether the haematoma is ruptured, rapidity of diagnosis and availability of therapeutic options. [1] This condition develops in PE when there are fibrin deposits in the liver vasculature that obstruct the sinusoids and lead to ischaemia, and subsequently to haemorrhage, haematoma and possibly hepatic rupture.…”

“…[5] The diagnosis of possible subcapsular haematoma of the liver is suspected on the basis symptoms, such as epigastric pain, right upperquadrant abdominal pain and nausea and vomiting in patients with PE and/or HELLP syndrome. [3,4] In the haemodynamically stable patient with symptoms and signs (tenderness or mass in the liver area) suspicious of a haematoma, ultrasound and/or computed tomography (CT) imaging can be used to confirm the diagnosis. [4] The diagnosis may also be made by direct visualisation of free blood in the abdominal cavity and identification of the liver lesion at the time of caesarean delivery for severe PE.…”

“…[3,4] In the haemodynamically stable patient with symptoms and signs (tenderness or mass in the liver area) suspicious of a haematoma, ultrasound and/or computed tomography (CT) imaging can be used to confirm the diagnosis. [4] The diagnosis may also be made by direct visualisation of free blood in the abdominal cavity and identification of the liver lesion at the time of caesarean delivery for severe PE. In a patient presenting with haemodynamic instability and acute abdominal pain, the diagnosis is usually made during an emergency laparotomy.…”

Transcatheter Arterial Embolization for Spontaneous Hepatic Rupture Associated with HELLP Syndrome: A Case Report

“…Transcatheter embolization of the hepatic artery for hepatic rupture associated with trauma or malignancy is a well-recognized treatment method. Nevertheless, endovascular management of spontaneous hepatic rupture associated with HELLP syndrome has been reported in few papers and referred to as a minor optional treatment in certain review articles [ 5 , 7 , 8 , 9 ]. Although TAE is widely used for the treatment of hepatic rupture, it appears that the occurrence of spontaneous hepatic rupture associated with HELLP syndrome is so rare that the use of TAE for the treatment of this condition is not well established.…”