Unexpected Subcapsular Hepatic Hematoma Rupture in HELLP Syndrome: A Case Report
ESSAIDI Zakaria
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
EL AZHARI Ilias
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
MASTAR Hajar *
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
ETTAOUSSI Abdelhak
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
KAMAL Khadija
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
MAJD Abdessamad
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
BOUALI Mounir
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
EL BAKOURI Abdelillah
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
EL HATTABI Khalid
Department of General Surgery, IBN ROCHD University Hospital of Casablanca, Casablanca, Morocco.
BENCHRIFI Yassine
Department of Obstetrics and Gynecology, IBN ROCHD University Hospital of Casablanca, Morocco.
WAJIH Oumeima
Department of Obstetrics and Gynecology, IBN ROCHD University Hospital of Casablanca, Morocco.
KAROUANI Doha
Department of Obstetrics and Gynecology, IBN ROCHD University Hospital of Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
The HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is considered a severe condition that may occur during pregnancy, carrying significant maternal and fetal risks. It can lead to multiple complications, including subcapsular liver hematoma (SLH), a potentially fatal consequence due to the risk of rupture.
We report the case of a 27-year-old primigravida at 32 weeks of gestation, who presented with acute abdominal pain and hemodynamic instability. Laboratory findings confirmed HELLP syndrome, and a ruptured subcapsular liver hematoma was suspected. An emergency cesarean section was performed without prior imaging, revealing massive hemoperitoneum and intrauterine fetal death. Further surgical exploration confirmed a ruptured SLH with active bleeding. Therefore, a perihepatic packing was performed. This case underscores the need for high clinical suspicion and rapid multidisciplinary intervention, as SLH rupture remains a rare but devastating complication of HELLP syndrome.
Keywords: Subscapular liver hematoma, SLH, rupture, HELLP syndrome, pregnancy