Subcapsular liver hematoma complicating HELLP syndrome: A case report and review of management strategies

Abstract

Subcapsular liver hematoma is a life-threatening complication of pregnancy. It is associated with preeclampsia and HELLP syndrome. We present the case of a 36-year-old Caucasian nulliparous woman who was diagnosed at 29 weeks and 6 days of gestation with mild preeclampsia. After brief hospitalization she was discharged. During a daily follow-up, at 31 weeks and 3 days of gestation, she complained of mild abdominal pain and blood tests revealed HELLP syndrome. The cervix was unripe. A healthy baby was delivered by emergency cesarean section. The following day, the patient complained of persistent abdominal pain, and at the same time the hepatic cytolysis worsened dramatically. A computed tomography (CT) scan revealed a significant subcapsular hematoma without any active bleeding or breach of Glisson's capsule. We treated the patient conservatively and she was discharged home 10 days after the diagnosis was made. The symptoms of subcapsular liver hematoma are non-specific. They include nausea, vomiting and epigastric pain, and pain in the right upper quadrant or shoulder. Biological analyses can show hepatic cytolysis, haemolysis and coagulation disorders. Medical imaging can confirm the diagnosis. The management of subscapular liver hematoma may depends on whether there is hemodynamic stability, active bleeding or breach of Glisson capsule's. If the patient is stable and in the absence of active bleeding, management should be purely symptomatic.

Keywords: HELLP syndrome; Preeclampsia; Pregnancy; SLH; Subscapular haematoma; Subscapular liver hematoma.

Fig. 1

Axial abdominal computed tomography with contrast at day 1 postpartum: presence of a right hepatic subcapsular collection of heterogeneous density indicated by a black star, measuring 44 mm × 160 mm.

Fig. 2

Frontal abdominal computed tomography with contrast at day 1 postpartum: presence of a right hepatic subcapsular collection of heterogeneous density indicated by a black star, measuring 44 mm × 160 mm.

Fig. 3

Axial abdominal computed tomography with contrast at day 8 postpartum: persistence of a right hepatic subcapsular collection of more homogenous density indicated by a black star, still measuring 44 mm × 160 mm.

Fig. 4

Frontal abdominal computed tomography with contrast at day 8 postpartum: persistence of a right hepatic subcapsular collection of more homogenous density indicated by a black star, still measuring 44 mm × 160 mm.