Hematoma subcapsular hepático roto en síndrome HELLP / Ruptured subscapular liver hematoma in context of HELLP syndrome

ABSTRACT

Background: Ruptured subscapular liver hematoma in context of HELLP syndrome is a rare complication with high mortality. Clinical presentation is nonspecific epigastric pain, right upper quadrant pain and shoulder pain, should however provide high index of suspicion. Termination of pregnancy is the only definitive treatment with a beneficial effect on the mother and the fetus. According to the hemodynamic status of the patient, treatment can be conservative through hepatic artery embolization, or surgical management, via contained packing of the bleeding area. Aim: To report seven cases of ruptured subscapular liver hematomas treated in a period of 13 years. Material and Methods: Review of medical records of patients discharged with the diagnosis from 2002 to 2015. Results: We identified seven women aged 30 to 44 years, for a total of 86,858 live births. At presentation, mean gestational age was 36 weeks. Five patients reported epigastric pain and three shoulder pain. All patients met the criteria for HELPP syndrome. All patients were operated on, and packing of the bleeding zone was carried out in six. One patient died. Two newborns died. Conclusions: The features of these patients may help in the management of this uncommon but severe condition.