Subcapsular Liver Hematoma Rupture in HELLP Syndrome During Pregnancy: A Case Study and Multidisciplinary Approach

BACKGROUND Spontaneous hepatic hematoma and liver capsule rupture is a rare but severe complication of Hemolysis, Elevated Liver Enzyme, and Low Platelet (HELLP) syndrome, with a high mortality rate. We report a case of a pregnant woman with HELLP syndrome and liver subcapsular hematoma rupture that was diagnosed during surgery. CASE REPORT A 35-year-old woman with 34+1 weeks of pregnancy came to the emergency department due to abdominal pain for 4 days. She was diagnosed with HELLP syndrome after a blood test. She was transferred to the obstetrics department, and an emergency cesarean section was performed under general anesthesia, due to fetal distress. During the surgery, non-clotting blood was found flowing out during the suturing of the incision. We suspended the surgery and organized an emergency multidisciplinary consultation. Subcapsular liver hematoma was diagnosed after intraoperative ultrasound detection. Emergency upper abdominal laparotomy was performed, and a ruptured liver capsule and active bleeding were found. The liver capsule was sutured and blood products were infused before the patient was sent to the intensive care unit. She recovered and was discharged 12 days after surgery. No special discomfort was reported during the 30-day follow-up after surgery. CONCLUSIONS Our case emphasizes that all parturients with abdominal pain and HELLP syndrome must be screened for spontaneous hepatic hematoma, and clinicians should pay attention to whether there is rupture of the liver capsule. Multidisciplinary consultations can increase the probability of successful rescue for such patients.