Successful Management of Intraoperatively Diagnosed Ruptured Spontaneous Sub-Capsular Liver Hematoma in a Woman with Preeclampsia

Spontaneously ruptured huge hepatic subcapsular hematoma associated with preeclampsia: A case report and literature review

Hepatic subcapsular hematoma (HSH) is an uncommon complication of pregnancy and is associated with elevated rates of maternal and foetal mortality. The rupture of an HSH is a critical situation that necessitates immediate and timely intervention to prevent loss of life. We present here, a case of a spontaneously ruptured massive HSH caused by preeclampsia. In addition, we conducted a comprehensive review of existing literature, encompassing 49 cases of HSH associated with pregnancy. If a pregnant woman with gestational hypertension experiences right upper abdominal pain with shoulder pain or radiating shoulder pain, it is crucial for her to have an urgent abdominal ultrasound because of the potential development of HSH and/or rupture. Our review of current literature suggests that opting for a caesarean section may offer notable advantages in preventing HSH rupture.

Spontaneous hepatic rupture during late pregnancy in a patient with solitary necrotic nodule of the liver: A case report

Background

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.

Case presentation

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 via 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.

Conclusion

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.

Ruptured Hepatic Hemangioma in the Third Trimester of Pregnancy: A Rare Case Report

Hepatic hemangiomas are considered the most common benign mesenchymal hepatic tumors. Most cases are asymptomatic. However, giant hemangiomas can present with a variety of clinical presentations, with a rupture being the most catastrophic outcome. Only a few cases of ruptured perinatal hepatic hemangiomas have been reported. Accelerated growth of hepatic hemangiomas caused by increased estrogen in pregnancy, increased intra-abdominal pressure, and direct contact with a gravid uterus are possible mechanisms for increased risk of rupture during pregnancy. The safety of either non-operative or surgical treatment of symptomatic giant hemangioma during pregnancy has not been adequately investigated. We present a rare case of a 28-year-old G1P0 female at 33 weeks gestation that presented with a ruptured hepatic hemangioma treated with damage control surgery followed by nonanatomic surgical resection.