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Federación Mexicana de Ginecología y Obstetricia, A.C.

2023, Number 11

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Ginecol Obstet Mex 2023; 91 (11)

Liver rupture: rare complication of HELLP syndrome. Case report and bibliographic review

Rodríguez VJC, Castillo LGE, Trujillo IC, Barrera GAG, Santos RAE, González MJ

Language: Spanish
References: 24
Page: 847-856
PDF size: 511.17 Kb.


ABSTRACT

Background: Hepatic rupture is an extremely rare complication in HELLP syndrome. The worldwide incidence of pregnancy-related hypertensive diseases is 4.5%, with liver rupture occurring in approximately 1 in 250,000 pregnancies. Mortality is high when it is present, which can be up to 90%.
Clinical case: A 34-year-old multigravida woman was admitted at 34.2 weeks of gestation to the emergency room due to clinical hypertensive encephalopathy and sudden onset of pain in epigastrium and hypochondrium. At admission hemodynamically stable, blood work only reported thrombocytopenia, hepatic function altered with elevated liver enzymes and hemolysis. The hepatic ultrasound reported hematoma subcapsular. An emergency laparotomy with c- section was performed with a massive hemoperitoneum was observed. A subcapsular hepatic hematoma with rupture and active hemorrhage managed with hepatic packing. However, the patient continued to incibleed, a second-look laparotomy was performed with active hemorrhage, which led to packing and 48 hours the removal of the packing. Her recovery was favorable and was discharged 16 days after her admission, with no subsequent complications.
Conclusions: The presentation of the case and bibliographic review suggests that hypertensive states of pregnancy, mainly preeclampsia, eclampsia and HELLP syndrome, are the main risk factor for the formation of a hepatic hematoma, and in exceptional cases the consequent rupture, even after delivery. Birth.


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