Ruptured liver capsule – HELLP syndrome'A 29-year old woman, 35 weeks pregnant with twins, developed right upper quadrant pain and collapsed. She was delivered of the twins (dead) and resuscitated. A CT scan showed blood around the liver. She continued to deteriorate and required 12 units of blood. She had a massively distended abdomen.
At laparotomy. six litres of blood was found free in the abdominal cavity. The source of the bleeding was a ruptured liver capsule with a large subcapsular haematoma.
The operative photograph shows the subcapsular haematoma with a long split in the capsule. The CT scan shows free blood in the peritoneal cavity.
This patient probably had the HELLP syndrome (H (hemolysis), EL (elevated liver enzymes), and LP (low platelet count).. The diagnosis of preeclampsia was never clearly established as the woman presented in a moribund state. However, she did have the other features of hemolysis, elevated liver enzymes and a low platelet count. The subcapsular haematoma presumeably occurred spontaneously as a result of the thrombocytopaenia. There was no history of trauma
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