A successful conservative management of ruptured subcapsular hepatic hematoma with pre-eclampsia

Abstract

Ruptured subcapsular hematoma of the liver is a rare complication of pregnancy, commonly associated with pre-eclampsia or HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome). We report a case of a 32-year-old woman, with no particular antecedents, admitted to our emergency department at 32 weeks of amenorrhea, for pre-eclampsia with epigastralgia. The liver ultrasound performed at admission was normal. In the presence of acute fetal distress, a caesarean section with midline vertical incision was performed urgently. The surgical exploration revealed massive haemoperitoneum with ruptured subcapsular hepatic hematoma. The management consisted of hepatic packing with massive transfusion. Removal of packing was performed on the fourth day after stabilization and regression of hepatic encephalopathy. Fortunately, the evolution was favorable and the patient was discharged after 4 weeks of hospital stay in stable condition. The ruptured subcapsular hematoma of the liver remains a very challenging situation and potentially life-threatening condition.