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Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Number 06

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Ginecol Obstet Mex 2018; 86 (06)

Hepatic subcapsular hematoma in HELLP syndrome. Report of 2 cases

Colín-Cortes HM, Ruvalcaba-Carrillo R, Olivares-Revilla DM, Yáñez-Torres JJO, Flores-Rodríguez JL, Rodríguez-Figueroa N, Vigna-Sánchez PA, Serna-Vela FJ, Robles-Martínez MC

Language: Spanish
References: 16
Page: 412-419
PDF size: 381.62 Kb.


ABSTRACT

Objective: Report clinical-surgical management and in the Obstetric Intensive Care Unit of the HELLP Syndrome and hepatic subcapsular hematoma of two clinical cases.
Clinical case A: 29 years of age, 36.1 weeks of gestation, absence of fetal movements, hypovolemic shock, premature detachment of normoinserta placenta, stillbirth. Hemoperitoneum finding of 2000 mL and subcapsular hematoma of the left hepatic lobe; Miculicz packaging is placed for 48 hours. Management in the Obstetric Intensive Care Unit for 9 days. Computed Axial Tomography reports hepatic subcapsular hematoma.
Clinical case B: 15 years of age, 38.6 weeks of gestation, pain in the hypogastrium and lumbar region, fetal bradycardia and HELLP syndrome; hemoperitoneum finding of 300 cc, product of 2,400 gr, Apgar 1-5, placental abruption of 100%, hepatic subcapsular hematoma contained by triangular ligament without the need for packaging. Management in the Obstetric Intensive Care Unit for 3 days. Computed Axial Tomography reports hepatic subcapsular hematoma.
Conclusion: The HELLP syndrome can present serious hepatic complications such as ruptured hepatic or subcapsular hematoma. Mortality is 18 to 86% in case of hema- toma rupture. They require management in highly complex centers. Early intervention, multidisciplinary management, hemodynamic support and follow-up with imaging studies are essential to reduce their high morbidity and mortality.


REFERENCES

  1. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 1982;142:159-167.

  2. Singh Y, Kochar S, Biswas M, Singh KJ. Hepatic Rupture Complicating HELLP Syndrome in Pregnancy. Med J Armed Forces India. 2009 Jan;65(1):89-90.

  3. Ghassan M, Hammoud MPH, Ibdah JA. Preeclampsia induced Liver Dysfunction, HELLP Syndrome, and Acute Fatty Liver of Pregnancy, AGAF Clinical Liver Disease. https://aasldpubs. onlinelibrary.wiley.com/doi/full/10.1002/cld.409.

  4. Hernández-García E, Nayola-Villalobos H, García-Nuñez LM, Portillo-Nuñez JA, Rebollo-Hurtado V, Pérez-Rodríguez JA. Tratamiento integral de pacientes con síndrome de Hellp y hematoma hepático roto. Recomendaciones para el cirujano general, ginecoobstetra. Reporte de un caso y revisión de la bibliografía. Rev. Sanid. Mililt Mex. 2016;70:214-219.

  5. Kapan M, Evsen MS, Gumus M, Onder A, Tekbas G. Subcapsular Liver hematoma in HELLP syndrome: Case Report. Gastroenterology Research, 2010;3(3):144-46. http:// www. doi. 10.4021/gr2010.04.178e

  6. Wicke C, Pereira PL, Neeser E, Flesch I, Rodegerdts EA, Becker HD. Subcapsular liver hematoma in HELLP syndro me: Evaluation of diagnostic and therapeutic options--a unicenter study. Am J Obstet Gynecol 2004;190(1):106-112.

  7. You JS, Chung YE, Chung HS, Joo Y, Chung SP, Lee HS. Spontaneous hepatic rupture caused by hemolysis, elevated liver enzymes, and low platelet count syndrome. Am J Emerg Med. 2014 Jun;32:(6):686.e3- 686.e4.

  8. Karateke A, Silfeler D, Karateke F, Kurt R, Guler A, Kartal I. HELLP Syndrome Complicated by Subcapsular Hematoma of Liver: A Case Report and Review of the Literature. Case Rep Obstet Gynecol. 2014;2014:585672. http://dx.doi. org/10.1155/2014/585672.

  9. Aghav PA. Rupture of Subcapsular Hematoma of Liver in Severe Preeclampsia with HELLP syndrome: A Nightmare to an Obstetrician. JCR 2016;6:26-29

  10. Abercrombie J. Hemorrhage of the liver. London Medical Gazette 1844;34: 792-94.

  11. Sibai, BM. HELLP Syndrome. Hepatic hematoma and rupture. Uptodate review. Jan 2018. URL: http://www.uptodate. com/contents/hellp-syndrome.

  12. Vigil-De Gracia P. Síndrome HELLP. Ginecol Obstet Mex 2015;83:48-57.

  13. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth 2009; 9,8. URL: http://Link.springer.com/article/ 10.1186/1471-2393- 9-8#enumeration.

  14. Cernea D, Dragoescu A, Novac M. HELLP Syndrome Complicated with Postpartum Subcapsular Ruptured Liver Hematoma and Purtscher-Like Retinopathy. Case Rep Obstet Gynecol. 2012;2012:856135. http://dx.doi. org/10.1155/2012/856135

  15. Sanabria-Padrón VH, Hernández-Valencia M, Castañeda- Valladares FE, Aceves-Solano JY. Tratamiento conservador del hematoma hepático en preeclampsia y síndrome de HELLP coexistentes: reporte de caso y revisión bibliográfica. Ginecol Obstet Mex 2013; 81:414-419.

  16. Perronne L, Dohan A, Bazeries P, Guerrache Y, Fohlen A, Rousset P, Aubé C, Laurent V, More O, Boudiaf M, Hoeffel C, Soyer P. Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features. Abdom Imaging. 2015;40(7):2839-49.




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