Wang Jilong, Yi Qilin, Guo Ya, Peng Tao
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Front Med (Lausanne). 2022 Oct 20;9:936006. doi: 10.3389/fmed.2022.936006. eCollection 2022.
Spontaneous hepatic rupture (SHR) during pregnancy is a rare and life-threatening event, which usually occurs together with preeclampsia, eclampsia, HELLP syndrome, or liver tumors. However, SHR resulting from solitary necrotic nodule of the liver (SNNL) is extremely rare.
We report the case of a 32-year-old pregnant woman who presented at 33 weeks of gestation with abdominal pain and emesis. Transabdominal ultrasound and magnetic resonance imaging revealed massive hemoperitoneum and lesions in the left lobe of the liver. An emergency cesarean section was performed and the hepatic rupture was managed surgically left lateral lobectomy. The postprocedural course was uneventful. The premature baby successfully survived, and the patient was discharged 8 days after admission without complications. Histological examination revealed a diagnosis of SNNL, which resulted in the hepatic hematoma and SHR.
To our knowledge, this is the first case of SHR resulting from SNNL during late pregnancy. Multidisciplinary collaboration and surgical management are important cornerstones for improving the perinatal outcomes when SHR is suspected in a pregnant patient.
妊娠期自发性肝破裂(SHR)是一种罕见且危及生命的事件,通常与子痫前期、子痫、HELLP综合征或肝脏肿瘤同时发生。然而,由肝脏孤立性坏死结节(SNNL)导致的SHR极为罕见。
我们报告一例32岁孕妇,在妊娠33周时出现腹痛和呕吐。经腹超声和磁共振成像显示大量腹腔积血和肝脏左叶病变。行急诊剖宫产,并通过手术(左外侧叶切除术)处理肝破裂。术后过程顺利。早产儿成功存活,患者入院8天后无并发症出院。组织学检查确诊为SNNL,导致肝血肿和SHR。
据我们所知,这是首例妊娠晚期由SNNL导致的SHR病例。多学科协作和手术管理是怀疑孕妇发生SHR时改善围产期结局的重要基石。