Managing Life-Threatening Spontaneous Liver Rupture in Pregnancy: A Case Study

BACKGROUND Spontaneous liver rupture during pregnancy is a rare but life-threatening condition with high maternal and perinatal mortality. It is commonly associated with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, preeclampsia, and liver-related diseases, making diagnosis and management challenging due to non-specific symptoms. Immediate intervention and a multidisciplinary approach are crucial for improving outcomes. CASE REPORT A 34-year-old primigravida woman at 35+5 weeks of gestation presented with severe epigastric pain, nausea, and vomiting. Initially treated for GERD, her symptoms persisted. Ultrasound revealed a fetus appropriate for gestational age (AGA) with normal well-being, amniotic fluid levels, and intact placental attachment. However, intra-abdominal visualization was limited due to advanced gestation and suspected bleeding around the uterus. As the patient's condition deteriorated, emergency surgery was performed, revealing a large liver mass rupture with significant intra-abdominal bleeding. Perihepatic packing was used for stabilization. Subsequent imaging identified a subcapsular hematoma in hepatic segments 2/3. A second surgery was performed, and a lateral segmentectomy was completed. Both the mother and baby recovered well, with the Jackson-Pratt drain removed on postoperative day 3 and discharge on day 7. CONCLUSIONS Spontaneous liver rupture, although rare, should be considered in pregnant patients with unexplained abdominal pain, even in the absence of typical risk factors. Early surgical intervention, timely imaging, and a multidisciplinary approach are critical for successful outcomes. Perihepatic packing serves as a lifesaving temporary measure to control bleeding and allow for further surgical planning.