پارگي خودبه‌خودي كبد در بارداري به‌دنبال سندرم HELLP : گزارش موردي

Spontaneous liver rupture in pregnancy complicating HELLP syndrome: case report

زمينه و هدف: پارگی خودبه‌خود كبد همراه با خونريزی يك عارضه نادر حاملگی بوده و اغلب با پره‌اكلامپسی توام با سندرم HELLP ديده می‌شود و می‌تواند با عارضه و مرگ‌و‌مير بالای مادر و جنين همراه باشد. در اين مطالعه يك مورد پارگی كبد به‌دنبال سندرم HELLP، در استان آذربايجان غربی گزارش شد. معرفی بيمار: خانم حامله 33 ساله G6D5 با سن حاملگی 30 هفته با سابقه فشارخون بالا، كاهش پلاكت و افزايش آنزيم‌های كبدی بود. در بررسی شكم بعد از سزارين متوجه خون و لخته در طرف راست شكم و پارگی كبد شده، محل خونريزی با لنگاز پك و شكم بسته شد. روز دوم، كبد با 10 عدد سرجی سل پك و فاسيا دوخته نشد. بيمار پس از چهل روز بستری مرخص شد. نتيجه‌گيری: در پارگی كبد با توجه به مشكل بودن تشخيص كلينيكی، می‌توان از روش‌های در دسترس مانند انجام سی‌تی‌اسكن و MRI، بهره‌مند گرديد.

Background: Spontaneous hepatic rupture is a rare condition during pregnancy. Pregnant women with Hemolysis, Elevated Liver enzymes and Low Platelete count (HELLP) syndrome are more susceptible to hepatic rupture. It can occur per 40000 to 250000 pregnancies with high mortality and morbidity. There is no agreement on the best approach to this severe pregnancy complication. This is the case report of a spontaneous hepatic rupture associated with HELLP syndrome during pregnancy which occurred for the first time in the West Azerbaijan Province, Iran. Case Presentation: A 33 years old lady gravida 6, 3 intrauterine fetal deaths, 2 neonatal deaths at 30th weeks of gestation was admitted for preeclampsia. On admission, she had thrombocytopenia and elevated liver enzyme. Cesarean section was performed due to fetal distress and a preterm fetus was born. Inspection of the abdomen revealed a large hematoma in the right liver lobe associated with rupture of the capsule. Liver packing was performed by general surgeon and the abdomen was closed without repairing of fascia. In the 2nd day after operation, the patient was oriented but the abdomen reopened because of very low blood pressure. There was no severe liver hemorrhage so the liver was packed again with many surgicels. She developed acute kidney and liver failure, pleural effusion and a major coagulopathy post-operatively. Three weeks after surgery the abdomen was reopened for dehiscence and fascia was closed. The patient discharged after 40 days. Conclusion: Spontaneous liver rupture associated with HELLP syndrome is a rare and life-threatening complication of pregnancy. Unruptured liver hematoma is also a rare condition during pregnancy with a very difficult diagnosis. Using clinical diagnostic tests such as CT scan or MRI would be helpful to improve clinical outcomes.