Spontaneous hepatic rupture during late pregnancy in a patient with solitary necrotic nodule of the liver: A case report

Abstract

BackgroundSpontaneous hepatic rupture (SHR) during pregnancy is a rare and life-threatening event, which usually occurs together with preeclampsia, eclampsia, HELLP syndrome, or liver tumors. However, SHR resulting from solitary necrotic nodule of the liver (SNNL) is extremely rare.Case presentationWe report the case of a 32-year-old pregnant woman who presented at 33 weeks of gestation with abdominal pain and emesis. Transabdominal ultrasound and magnetic resonance imaging revealed massive hemoperitoneum and lesions in the left lobe of the liver. An emergency cesarean section was performed and the hepatic rupture was managed surgically via left lateral lobectomy. The postprocedural course was uneventful. The premature baby successfully survived, and the patient was discharged 8 days after admission without complications. Histological examination revealed a diagnosis of SNNL, which resulted in the hepatic hematoma and SHR.ConclusionTo our knowledge, this is the first case of SHR resulting from SNNL during late pregnancy. Multidisciplinary collaboration and surgical management are important cornerstones for improving the perinatal outcomes when SHR is suspected in a pregnant patient.

Rotura hepática espontánea en puérpera sin enfermedad hipertensiva del embarazo ni enfermedad hepática: Reporte de caso

“…El 2003-2013, en el IMMP se reportaron 26 casos y en el 96.2% la causa fue preeclampsia severa, la mayoría de pacientes requirieron hemoderivados más ventilación mecánica 6 . La rotura hepática es poco frecuente en gestantes con enfermedades hepáticas como nódulos, hemangiomas, peliosis, colangiocarcinoma y otras lesiones benignas hepáticas 7,8,9,10,11 ; y es extremadamente infrecuente que ocurra entre gestantes sin hipertensión o enfermedad hepática 12 .…”