2287 HELLP My Liver Hematoma

Abstract

INTRODUCTION: Pregnant females are at increased risk of hypertensive conditions including preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. Complications related to these disorders can be life-threatening and can result in multi organs failure. These complications involve disseminated intravascular coagulation (DIC), stroke, acute renal failure, acute liver injury, hepatic hematoma, and rupture. CASE DESCRIPTION/METHODS: We describe a 34-year-old G2P1 female at 36-weeks gestation with no significant past medical history, who presented with abdominal pain for the last couple of days prior to her emergency room (ER) visit. She described the pain as dull, constant, and worsening right upper quadrant pain associated with nausea but no vomiting, fever, chills, jaundice or changes to bowel habits. On presentation, she was noted to be in a stable condition. The physical exam was consistent with tight upper quadrant tenderness with no signs of acute abdomen. The initial workup was significant for leukocytosis of 13.8, hemoglobin of 11.9, mildly elevated liver enzymes with AST of 270, ALT of 346, ALP of 165 (normal liver tests during her recent pre-natal visits). Abdominal ultrasound revealed a normal appearance of the liver with no signs of gallbladder disease. The rest of her work up was unremarkable on admission. Her condition got worse with markedly elevated liver enzymes that peaked at 2500s range and diminished platelet count concerning for the diagnosis of HELLP syndrome. She underwent a successful urgent cesarean section in the setting of deceleration of fetal heart tracing that was complicated by hypotension requiring pressor support. She was noted to have a liver hematoma intra-operatively. Abdominal CT post-operatively confirmed extensive heterogeneous sub-capsular hepatic hematoma with a small amount of ascites but not evidence of extravasation (Figure 1,2). The patient was managed conservatively in the intensive care unit (ICU) after her operation and her condition improved gradually. DISCUSSION: HELLP syndrome is a life-threating condition that carries a high morbidity and mortality burden. Hepatic hematoma and spontaneous liver rupture have been described previously as fatal complications. A high index of suspicion is required for early diagnosis and prompt treatment of such conditions.