HELLP Syndrome Complicated by Subcapsular Hematoma of Liver: A Case Report and Review of the Literature

Subcapsular liver hematoma (SLH) is a rare complication of severe preeclampsia and HELLP syndrome. These patients must be followed up in intensive care unit for advanced medical support with infused fluid, replacement of blood products, and treatment of underlying disorders. There are a lot of therapeutic options varying from conservative management to surgical treatment including hepatic resection, hepatic artery ligation, and liver transplantation. In this report we aimed to present a 26-year-old woman with SLH secondary to HELLP syndrome. 1. Introduction Subcapsular liver hematoma (SLH) has been reported in less than 2% of pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). The incidence of SLH has been reported, 1/40.000 to 1/250.000, leading to increased rate of both maternal and perinatal morbidity and mortality [1, 2]. The symptoms of SLH may represent as epigastric, right upper quadrant or shoulder pain, abdominal distension, nausea and vomiting. SLH may result in hepatic rupture and therefore may cause life-threatening problems such as disseminated intravascular coagulation (DIC), acute liver, and kidney failure. In this paper, we reported a patient with SLH who was managed conservatively and reviewed the literature. 2. Case Report A 26-year-old woman, gravida 3, parity 2, was admitted at 29 weeks of gestation with preeclampsia to our clinic. The patient’s complaints were increasing headache on frontal side and visual impairment. Her past medical and family history was unremarkable. Arterial blood pressure was 170/90？mmHg and laboratory findings revealed serum aspartate aminotransaminase (AST): 350？IU/L (N: 5–34), serum alanine aminotransaminase (ALT): 450？IU/L (N: 0–55), serum lactate dehydrogenase (LDH): 480？IU/L (N: 125–243), serum urea and creatine to be normal, white blood cell (WBC): 13200/mm3 (N: 4000–11000), hemoglobin (Hb): 10.6？mg/dL (N: 11.5–16.0), and platelet count (Plt): 90.000/mm3 (N: 150.000–450000). A catheterized urine specimen demonstrated proteinuria (++). In obstetrical ultrasonography (USG), fetal heart rate (FHR) was 140/minute and fetal measurement was compatible with 29 weeks of gestation. The patient was hospitalized for diagnosis of elevated liver enzymes and low platelets in suspicion of HELLP syndrome. Despite the fact that intravenous magnesium sulfate was given to the patient, after two hours of hospitalization, she had convulsion. USG was done by a senior obstetrician and showed FHR to be negative. After patient’s approval and given necessary knowledge about