University of Kentucky Bowling Green, KY, United States
Syed Naqvi, MD1, Hassnain Syed, MD1, Rachel Whittaker, 1, Abrar Arshad, MD2, Diego Cabrera, MD2 1University of Kentucky, Bowling Green, KY; 2Medical Center Bowling Green, Bowling Green, KY
Introduction: Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a complication of maternal pre-eclampsia, which is characterized by new-onset hypertension and proteinuria that develops after 20 weeks' gestation. HELLP syndrome will affect approximately 10-20% of women with severe preeclampsia. Subcapsular liver hematoma represents accumulation of blood between the capsule of Glisson and the liver parenchyma. Early diagnosis of subcapsular liver hematoma is critical, as treatment can vary from conservative management to emergent laparotomy, depending on the patient’s clinical status. Subcapsular hematoma of the liver is potentially fatal complication of pregnancy-related HELLP syndrome. We present a case of a 31-year-old female with subcapsular liver hematoma secondary to HELLP syndrome.
Case Description/Methods: A 31-year old woman, at 41 weeks’ gestation, was examined status post spontaneous vaginal delivery. Four hours postpartum, she was found to be hypotensive. Her hemoglobin acutely dropped from 13.3 g/dL to 9.8 g/dL. Urgent suction dilation and curettage (D&C) was performed with placement of an intrauterine Bakri balloon. Following the suction D&C, her AST, ALT, and LDH steadily increased, measuring 7960 U/L, 3269 U/L, and 12,110 U/L, respectively. Platelets on admission were 134,000/uL, which fell to 29,000/uL. A CT abdomen/pelvis confirmed a large subcapsular hematoma around the right lobe of the liver with associated hemoperitoneum. The patient was started on treatment dose of IV corticosteroids and referred to hepatobiliary surgery.
Discussion: Subcapsular liver hematoma is a rare complication of HELLP syndrome, which occurs in less than 2% of patients. The pathogenesis of hepatic hematoma formation is complex and not well understood, though it is thought to involve fibrin deposition leading to platelet activation, thrombus formation, and occlusion of capillaries. Subcapsular liver hematomas can become rapidly fatal, especially if it progresses to hepatic rupture. Therefore, the maternal mortality rate of subcapsular liver hematoma ranges greatly between 17% to 59%. A vast majority of women develop HELLP syndrome prior to delivery, typically between the 26th and 34th week of gestation. Interestingly, our patient developed symptoms four hours following delivery. This case aims to promote vigilant awareness of subcapsular hematoma in HELLP syndrome-a rare, yet detrimental complication of HELLP syndrome.
Syed Naqvi indicated no relevant financial relationships.
Hassnain Syed indicated no relevant financial relationships.
Rachel Whittaker indicated no relevant financial relationships.
Abrar Arshad indicated no relevant financial relationships.
Diego Cabrera indicated no relevant financial relationships.
Syed Naqvi, MD1, Hassnain Syed, MD1, Rachel Whittaker, 1, Abrar Arshad, MD2, Diego Cabrera, MD2. P1897 - Post-Partum HELLP With Subcapsular Liver Hematoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.