Download PDF
CC BY 4.0 · Libyan International Medical University Journal 2023; 08(02): 060-062
DOI: 10.1055/s-0043-1776339
Case Report

Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome

Abtisam Alharam 
1   Department of General Surgery, Benghazi Medical Center, Benghazi, Libya
,
Tawfik Abuzalout
2   Department of Surgery, Benghazi University, Benghazi, Libya
,
Haitham Elmehdawi 
3   Department of Surgery, Libyan International Medical University, Benghazi, Libya
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Abstract

This case report highlights the rare and life-threatening complication of ruptured subscapular liver hematoma in the setting of hemolysis, elevated liver enzymes, and low platelets syndrome, a complication associated with pre-eclampsia. A 30-year-old pregnant woman at 38 weeks of gestation presented with high blood pressure, exaggerated neurological reflexes, and high levels of albumin in her urine. Her condition deteriorated over time, and liver function tests revealed elevated readings. An emergency cesarean section was performed, during which a large liver tear with active bleeding and rupture of the liver capsule in the right lobe were discovered. An exploratory laparotomy revealed a massive hemoperitoneum with active bleeding, and hepatic packing was performed using three gauzes. Despite this, the patient's liver parameters continued to worsen, and she was transferred to the intensive care unit for further resuscitation. After 72 hours, she underwent a second operation to remove the gauze packing, and hemostasis was successfully achieved without any active bleeding. Early detection of ruptured subcapsular liver hematoma and a coordinated approach involving medical, obstetrical, radiology, and surgical teams can lead to successful treatment of this rare and dangerous complication.

Zoom Image

Keywords

subcapsular liver hematoma - HELLP syndrome - liver injury - pregnancy


Publication History

Article published online:
13 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 García González LA, Rodríguez Uría R, Noriega Menendez P. et al. Ruptured subcapsular liver hematoma as a rare complication of HELLP syndrome. A therapeutic challenge. Rev Esp Enferm Dig 2023; 115 (08) 465-466
    PubMedSearch in Google Scholar
  • 2 Grigorakis S, Tzimas GN, Alexakis C, Morea BE, Kontomitros N. Subcapsular liver hematoma: a rare complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome managed conservatively. Cureus 2022; 14 (02) e22058
    PubMedSearch in Google Scholar
  • 3 Singh P, Warren K, Collier V. Ruptured subcapsular liver hematoma: a rare complication of HELLP syndrome. Case Reports Hepatol 2020; 2020: 8836329
    CrossrefPubMedSearch in Google Scholar
  • 4 Wicke C, Pereira PL, Neeser E, Flesch I, Rodegerdts EA, Becker HD. Subcapsular liver hematoma in HELLP syndrome: evaluation of diagnostic and therapeutic options–a unicenter study. Am J Obstet Gynecol 2004; 190 (01) 106-112
    CrossrefPubMedSearch in Google Scholar
  • 5 Henríquez-Villaseca MP, Catalán-Barahona A, Lattus-Olmos J, Vargas-Valdebenito K, Silva-Ruz S. Hematoma subcapsular hepático roto en síndrome HELLP. [Ruptured subscapular liver hematoma in context of HELLP syndrome.]. Rev Med Chil 2018; 146 (06) 753-761
    CrossrefPubMedSearch in Google Scholar
  • 6 Mazzola A, Magro B, Perdigao F. et al. Acute liver failure and HELLP syndrome: a clinical case and literature review. Clin Res Hepatol Gastroenterol 2021; 45 (02) 101498
    CrossrefPubMedSearch in Google Scholar
  • 7 Gupta M, Feinberg BB, Burwick RM. Thrombotic microangiopathies of pregnancy: differential diagnosis. Pregnancy Hypertens 2018; 12: 29-34
    CrossrefPubMedSearch in Google Scholar
  • 8 Poimenidi E, Metodiev Y, Archer NN, Jackson R, Bangash MN, Howells PA. Haemolysis, elevated liver enzymes and low platelets: diagnosis and management in critical care. J Intensive Care Soc 2022; 23 (03) 372-378
    CrossrefPubMedSearch in Google Scholar
  • 9 Stojanovska V, Zenclussen AC. Innate and adaptive immune responses in HELLP syndrome. Front Immunol 2020; 11: 667
    CrossrefPubMedSearch in Google Scholar
  • 10 Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol 2016; 64 (04) 933-945
    CrossrefPubMedSearch in Google Scholar
  • 11 Wilson SG, White AD, Young AL, Davies MH, Pollard SG. The management of the surgical complications of HELLP syndrome. Ann R Coll Surg Engl 2014; 96 (07) 512-516
    CrossrefPubMedSearch in Google Scholar
  • 12 Marinelli A, Hill J. Management of ruptured subcapsular liver hematoma as a result of hemolysis, elevated liver enzyme, and low platelet syndrome in a rural facility. Cureus 2023; 15 (01) e33852
    PubMedSearch in Google Scholar