medigraphic.com
Colegio de Medicina Interna de México.

2019, Number 2

<< Back Next >>

Med Int Mex 2019; 35 (2)

Postpartum subcapsular hepatic hematomas in HELLP syndrome

López-Islas I, De la Cerda-Ángeles JC, Maxil-Sánchez AJ, Vásquez- Vásquez JE

Language: Spanish
References: 14
Page: 302-307
PDF size: 237.74 Kb.


ABSTRACT

HELLP syndrome is a complication of pregnancy that can be fatal when subcapsular hepatic hematoma or hepatic rupture occurs, its management can be conservative or can include embolization of the hepatic artery, surgical drainage and even liver transplantation. This paper reports the case of a 37-year-old multiparous patient who presented preeclampsia and in the postpartum hepatic subcapsular hematomas that initially required conservative management, later supraselective embolization of the right hepatic artery and finally exploratory laparotomy with drainage of hematomas and open cholecystectomy due to vesicular necrosis, as well as surveillance for post-surgical residual hepatic hematomas. She was discharged stable in cardiohemodynamic and respiratory terms. The timely diagnosis and treatment of subcapsular hepatic hematoma in patients with HELLP syndrome can reduce mortality; clinical, biochemistry and imaging studies monitoring are important.


REFERENCES

  1. 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(1):106-112.

  2. Sibai BM, Ewell M, Levine RJ, Klebanoff MA, Esterlitz J, Catalano PM, Goldenberg RL, Joffe G. Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997;177:1003-10.

  3. Abercombie J. Case of hemorrhage of the liver. London Medical Gazzette 1844;34:792.

  4. Ndzengue A, Hammoudeh F, Brutus P, et al. An obscure case of hepatic subcapsular hematoma. Case Reports Gastroenterol 2011;5(1):223-226.

  5. Carlson KL, Bader CL. Ruptured subcapsular liver hematoma in pregnancy: a case report of nonsurgical management. Am J Obstet Gynecol 2004;190:558-60.

  6. Cernea D, Dragoescu A, Novac M. HELLP syndrome complicated with postpartum subcapsular ruptured liver hematoma and purtscher-like retinopathy. Case Rep Obstet Gynecol 2012, doi:10.1155/2012/856135

  7. Sheikh RA, Yasmeen S, Paul y MP, Riegler JL. Spontaneous intrahepatic hemorrhage and hepatic rupture in the HELLP syndrome: Four cases and a review. J Clin Gastroenterol 1999;28:323-8.

  8. Mohr AM, Lavery RF, Barone A, et al. Angiografhic embolization for livers injuries: low mortality, high morbidity. J Trauma 2003;55:1077-81; discussion 1081-2.

  9. Miguelote RF, Costa V, Vivas J, Gonzaga L, Alpoim Menezes C. Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome. Arch Gynecol Obstet 2009;279:923-926.

  10. Hunter SK, Martin M, Benda JA, Zlantnik FJ. Liver transplant after massive spontaneous hepatic rupture in pregnancy complicated by preeclampsia. Obstet Gynecol 1995;85:819-22.

  11. Reed RL, Merrell Rc, Meyers WC, Fischer RP. Continuing evolution in the approach to severe liver trauma. Ann Surg 1992;216:524-38.

  12. Sánchez L, Olivares JM, Valdés V, Millán MP, Rodríguez C. Hígado graso agudo del embarazo, una patología infradiagnosticada. A propósito de 2 casos clínicos. Prog Obstet Ginecol 2015;58(2):81-87.

  13. Liu J, Ghaziani TT, Wolf JL. Acute fatty liver disease of pregnancy: Updates in pathogenesis, diagnosis and management. Am J Gastroenterol 2017;112:838-846.

  14. Neave L, Scully M. Microangiopathic hemolytic anemia in pregnancy. Transfus Med Rev 218. https://doi. org/10.1016/j.tvrv.2018.08.002




2020     |     www.medigraphic.com