Korean J Hepatobiliary Pancreat Surg.  2003 Jun;7(1):144-147.

Spontaneous Hepatic Rupture Following an Uncomplicated Pregnancy and Delivery

• Kim DH
• Hong BH
• Lee TS
• Han JK
• Cho SB
• Hong SY

Abstract

Spontaneous rupture of the liver in pregnancy is extremely uncommon. The most of cases have occurred in pregnancy with preeclampsia/eclampsia. We report one case of spontaneous capsular rupture following an uncomplicated pregnancy. A 33 year old woman was admitted at 38 weeks of gestation to the Obstetrics department. On admission her pulse and blood pressure were normal and there was no proteinuria. On the next day, a cesarean section was performed with delivery of a male infant (3.8 kg). but persistent uterine bleeding was developed due to uterine atony. and then subtotal hysterectomy was performed. Postoperatively she was remained unstable requiring further transfusion of blood and fresh frozen plasma. She was reoperated for controling persistent bleeding and evacuation hematoma of previous hysterectomy site. Postoperatively she was stable during 48 hours. However she again became hypotensive and on examination was noted intra-abdominal fresh bleeding. Laboratory evaluation demonstrated a high level of LFT. Contrast enhanced CT revealed subcapsular hematoma rupture and active bleeding of liver. We tried to embolized the terminal hepatic arterial branch for controling the ruptured subcapsular hematoma. and then she was stable but after 5th days, liver necrosis was developed and progressed to abscess. Despite radiologic drainage, necrotic abscess was remained persistently. She was managed with open drainage and debridement of necrotic liver. After 2 weeks, she was discharged without any morbidity.

Keyword

Hepatic subcapsular hematoma; Pregnancy; Spontaneous hepatic rupture

MeSH Terms

Abscess
Adult
Blood Pressure
Cesarean Section
Debridement
Drainage
Female
Hematoma
Hemorrhage
Humans
Hysterectomy
Infant
Liver
Male
Necrosis
Obstetrics and Gynecology Department, Hospital
Plasma
Pregnancy*
Proteinuria
Rupture*
Rupture, Spontaneous
Uterine Hemorrhage
Uterine Inertia