HELLP Syndrome with Hepatic and Thoracic Complications: Insights From a Case of Spontaneous Liver Rupture

BACKGROUND Spontaneous hepatic rupture during pregnancy is a rare but life-threatening complication, closely associated with HELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome. The concomitant occurrence of thoracic hemorrhage can lead to catastrophic outcomes. Early recognition and multidisciplinary management are critical, yet diagnostic challenges often delay intervention. CASE REPORT This report describes a case of a 29-year-old multiparous woman who presented with sudden epigastric pain and intrauterine fetal death at 37 weeks of gestation. Due to a prior history of cholelithiasis, the patient was initially misdiagnosed with biliary colic, leading to a delayed recognition of HELLP syndrome. Emergency cesarean section revealed a rupture of the left hepatic lobe with massive hemoperitoneum (blood loss up to 3000 ml). Despite surgical suturing and tamponade for hemostasis, refractory hemorrhagic shock necessitated urgent transcatheter arterial embolization (TAE). Postoperatively, thoracic hemorrhage complicated the course but was managed with blood transfusion and drainage. After 48 days of treatment, the patient stabilized and was discharged. CONCLUSIONS This case report highlights the critical importance of maintaining high clinical suspicion for HELLP syndrome's catastrophic complications, including hepatic rupture and thoracic hemorrhage. Optimal outcomes require a triad of rapid diagnosis, prompt stabilization, and well-coordinated multidisciplinary care.