The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People's Hospital, Hangzhou, China.
Department of Hepatobiliary Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China.
Medicine (Baltimore). 2024 Nov 1;103(44):e40285. doi: 10.1097/MD.0000000000040285.
Spontaneous subcapsular hepatic hematoma (SSHH) is a rare yet severe complication of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome that can lead to life-threatening situations for both the mother and fetus. Determining an appropriate therapeutic strategy remains challenging, as it involves choosing between surgery, microinvasive percutaneous transhepatic drainage, or conservative treatment alone. Further successful cases are needed to support the optimal option. We retrospectively collected a patient's clinical record and imaging data to elucidate the natural progression, response to noninvasive treatment, and outcome of SSHH associated with HELLP syndrome.
A 34-year-old woman, who underwent a cesarean section due to suspected fetal distress, developed SSHH accompanied by the potential risk of rupture and deteriorated serology within the first 24 hours after delivery.
Emergency blood routine examination, serum biochemistry analysis, and computed tomography of the abdomen revealed a SSHH associated with HELLP syndrome.
The main rescue measures included the use of corticosteroids, antihypertensive drugs, and platelet transfusion.
A positive effect on the patient's condition was exhibited within 24 to 48 hours. The majority of the subcapsular hepatic hematoma could be absorbed without any sequelae over a period of 7 months.
For patients with pregnancy-induced hypertension, there is a heightened risk of HELLP syndrome occurrence in subsequent pregnancies. The assessment and treatment of SSHH should be conducted by an experienced multidisciplinary team. In addition to timely delivery, the administration of corticosteroids, usage of antihypertensive medication, and platelet transfusion are necessary, particularly within the first 48 hours if the patient's condition permits. This approach would provide valuable insights for further therapeutic decisions and facilitate a preliminary prognosis assessment.
自发性肝包膜下血肿（SSHH）是溶血、肝酶升高和血小板计数降低（HELLP）综合征的一种罕见但严重的并发症，可导致母婴生命受到威胁。确定适当的治疗策略仍然具有挑战性，因为它涉及到在手术、微创经皮肝穿刺引流和单纯保守治疗之间进行选择。需要更多成功的病例来支持最佳选择。我们回顾性收集了一位患者的临床记录和影像学资料，以阐明与 HELLP 综合征相关的 SSHH 的自然病程、对非侵入性治疗的反应和结果。
一位 34 岁的女性，因疑似胎儿窘迫而行剖宫产术，在分娩后 24 小时内出现 SSHH，伴有破裂的潜在风险和血清学恶化。
急诊血常规检查、血清生化分析和腹部计算机断层扫描显示与 HELLP 综合征相关的 SSHH。
主要抢救措施包括使用皮质类固醇、降压药和血小板输注。
患者病情在 24 至 48 小时内出现好转。7 个月后，大部分包膜下肝血肿吸收，无任何后遗症。
对于妊娠高血压患者，在随后的妊娠中发生 HELLP 综合征的风险增加。应通过有经验的多学科团队评估和治疗 SSHH。除了及时分娩外，皮质类固醇、降压药物和血小板输注也是必要的，尤其是在患者情况允许的情况下，应在 48 小时内进行。这为进一步的治疗决策提供了有价值的见解，并有助于初步预后评估。
