A case of spontaneous hepatic rupture in a patient with primary hepatocellular carcinoma during the puerperium / 대한산부인과학회지

Hepatocellular carcinoma associated with pregnancy is rarely encountered, since hepatocellular carcinoma is usually developed after childbearing ages and severe menstrual irregularity and infertility with disturbance of estrogen metabolism is often accompanied with cirrhosis that is a most common underlying disease of primary hepatocellular carcinoma. Spontaneous hepatic rupture in pregnancy is a rare condition associated with significant maternal and perinatal mortality and could be developed related with severe preeclampsia and especially HELLP syndrome but possible related with hepatocellular carcinoma. We report a case of spontaneous hepatic rupture during the puerperium in a patient with hepatocellular carcinoma with a brief review of literatures.

Spontaneous Hepatic Rupture Following an Uncomplicated Pregnancy and Delivery / 한국간담췌외과학회지

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.