Hepatic hematoma rupture in HELLP syndrome and hypertensive crisis a combination with a catastrophic result

Abstract

Female, 32 years G2P1001, 29 weeks pregnancy, consults for epigastric pain irradiated to right costal margin and findings of acute hypertensive disorder and HELLP syndrome criteria, no surgical or medical history. She requires intravenous antihypertensive therapy with labetalol, hydralazine and nitroglycerine for the management of the hypertensive crisis associated to acute lung edema. Cesarean delivery was performed, she was transfered on post-surgical to intensive care unit to continue arterial pressure control with antihypertensive, diuretic and oxygen support with high flow nasal cannula. On her second post-surgical day after a valsalva maneuver, she describes an intense abdominal pain and serosanguinous drainage through surgical wound, she passes to surgical room where an hepatic hematoma rupture of V and VI segments is found, a liver packing is performed in a control damage surgery context.