Spontaneous hepatic rupture after mitral valve replacement for infective endocarditis in pregnancy: a case report

Spontaneous liver rupture during pregnancy is rare and is mostly related to hypertension, eclampsia, or underlying hepatobiliary diseases. Hepatic rupture due to infective endocarditis is even less common.

We report a pregnant woman at 32 weeks gestation without hypertension and underlying hepatobiliary disease who underwent mechanical mitral valve replacement for infective endocarditis. Low molecular weight heparin 0.4 ml q12h was used, and it was changed to warfarin on the third postoperative day (POD). On POD5, the patient developed liver rupture and intrauterine fetal death. After accepting blood transfusion, the hemoglobin level still decreased. On POD6, we performed an exploratory laparotomy and found a rupture in the right lobe of the liver, followed by liver rupture repair packing and cesarean section. But the patient still had obviours abdominal drainage. At night, the interventional radiologist performed an emergency liver arteriography, which revealed bleeding from the right hepatic artery branch, and interventional embolization was performed. Finally, the hemodynamics became stable. The patient was discharged 2 weeks later. Three months after surgery, an enhanced CT scan indicated that the liver had basically returned to normal.

Infection can lead to liver rupture in pregnancy without high blood pressure. Appropriate targeted antibiotic therapy is essential and should be accompanied by prompt surgical or endovascular treatment to improve maternal and fetal outcomes.