Sanabria-Padrón Víctor Hugo, Hernández-Valencia Marcelino, Castañeda-Valladares Florencia Elena, Aceves-Solano Jacqueline Yuliana
Médico adscrito al servicio de Ginecología y Obstetricia, Hospital Regional de Tlalnepantla, Estado de México, ISSEMyM.
Ginecol Obstet Mex. 2013 Jul;81(7):414-9.
Liver hematoma is a rare and serious complication of pregnancy associated with preeclampsia-eclampsia and HELLP syndrome.
27 years old patient with two pregnancies, first pregnancy with eclampsia, admitted with 36.5 weeks of gestation, blood pressure of 140-100 mmHg, epigastric pain, shoulder pain without peritoneal irritation and increased tendon reflexes. The requested preeclamptic profile supports the diagnosis of severe preeclampsia and HELLP syndrome. It was decided to terminate the pregnancy by abdominal route. Male product was obtained alive, 2,060 g, Apgar 8/9, gestational age of 38.2 weeks Capurro. A review did not report liver parenchymal. The evolution during mediate puerperium was torpid, the patient presented epigastric pain and shoulder pain, and there was a rise in transaminases (AST 687 U/L, ALT 813 U/L), progressive thrombocytopenia (113, 103/ pL), decreased hemoglobin, proteinuria and hypovolemic shock. Abdominal CT scan was requested, and it confirmed a heterogeneous liver image (117 x 85 x 104 mm) with a volume of 694 cc, suggesting hepatic hematoma. Serialized control of abdominal CT indicated liver hematoma resorption after 25 days of hospitalization. Seven days after discharge transaminase levels were normal.
To consider in the diagnosis of preeclampsia and HELLP syndrome the likelihood of liver hematoma as an acute complication; early treatment improves the prognosis.
肝血肿是妊娠罕见且严重的并发症，与子痫前期-子痫及HELLP综合征相关。
一名27岁有两次妊娠史的患者，首次妊娠并发子痫，孕36.5周入院，血压140/100 mmHg，上腹部疼痛、肩部疼痛，无腹膜刺激征，腱反射亢进。所要求的子痫前期检查结果支持重度子痫前期及HELLP综合征的诊断。决定经腹终止妊娠。娩出一活男婴，体重2060 g，阿氏评分8/9分，孕龄38.2周（卡普洛法）。复查未报告肝实质情况。产褥期中期病情进展缓慢，患者仍有上腹部疼痛及肩部疼痛，转氨酶升高（谷草转氨酶687 U/L，谷丙转氨酶813 U/L），血小板进行性减少（113、103/μL），血红蛋白降低，蛋白尿及低血容量性休克。遂行腹部CT扫描，证实肝脏有一不均匀影像（117×85×104 mm），体积694 cc，提示肝血肿。腹部CT的系列检查显示住院25天后肝血肿吸收。出院7天后转氨酶水平恢复正常。
在子痫前期及HELLP综合征的诊断中应考虑肝血肿作为急性并发症的可能性；早期治疗可改善预后。
