Mukherjee Gargi, Guirgis Naguib Fayez Naguib, Ajay Bini, Banerjee Indranil, Khalil Miriam
Obstetrics and Gynaecology, Surrey and Sussex NHS Trust, Redhill, GBR.
Obstetrics and Gynaecology, Croydon University Hospital NHS Trust, London, GBR.
Cureus. 2024 Nov 23;16(11):e74299. doi: 10.7759/cureus.74299. eCollection 2024 Nov.
Subcapsular liver haematoma in pregnancy, a rare and life-threatening condition, is more commonly associated with severe preeclampsia and haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. The common presenting symptom of subcapsular haematoma is acute-onset upper abdominal pain in patients suffering from preeclampsia; shock is the presenting feature in severe cases of rupture. Here we have discussed a case of subcapsular haematoma associated with HELLP syndrome in a patient who responded to conservative management. The diagnosis of subcapsular haematoma was delayed as the clinical presentation was atypical. A 30-year-old primigravida with an apparently uncomplicated pregnancy attended with sudden onset acute abdominal pain in Croydon University Hospital, London, UK. Due to associated cardiotocography (CTG) concerns, the initial diagnosis was placental abruption. An urgent caesarean section was performed, and a spontaneous hemoperitoneum of 500 ml was found during the surgery. Following the caesarean section, the blood pressure started to rise. Subsequently, the blood picture deteriorated to full-blown HELLP syndrome, and the pain worsened. Further imaging revealed a large subcapsular haematoma of the liver. The patient was managed conservatively in the intensive therapy unit (ITU) by a multidisciplinary team including intensivists, an upper gastrointestinal surgeon, and an obstetric team. She responded to conservative management and had an uneventful recovery. A high index of suspicion in cases of severe pain in the abdomen during pregnancy can help in early diagnosis. Moreover, further exploration in the case of spontaneous hemoperitoneum during caesarean section should be considered to avoid delay in diagnosis. Prompt intervention by the pertinent teams is the key to successful treatment.
妊娠期肝包膜下血肿是一种罕见且危及生命的疾病，更常与重度子痫前期及溶血、肝酶升高和血小板减少（HELLP）综合征相关。肝包膜下血肿的常见表现症状是子痫前期患者突发上腹部疼痛；严重破裂病例的表现特征是休克。在此，我们讨论了一例与HELLP综合征相关的肝包膜下血肿病例，该患者对保守治疗有反应。由于临床表现不典型，肝包膜下血肿的诊断被延迟。一名30岁初产妇，孕期看似正常，因突发急性腹痛就诊于英国伦敦克罗伊登大学医院。由于相关的胎心监护（CTG）问题，最初诊断为胎盘早剥。遂紧急行剖宫产术，术中发现500毫升自发性血腹。剖宫产后，血压开始上升。随后，血常规检查结果恶化为典型的HELLP综合征，疼痛加剧。进一步影像学检查显示肝脏有一个大的包膜下血肿。该患者在重症监护病房（ITU）由包括重症监护医生、上消化道外科医生和产科团队在内的多学科团队进行保守治疗。她对保守治疗有反应，恢复过程顺利。对妊娠期严重腹痛病例保持高度怀疑有助于早期诊断。此外，剖宫产术中出现自发性血腹时应考虑进一步探查，以避免诊断延误。相关团队的及时干预是成功治疗的关键。
