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Liver Embolization for Subcapsular Hematoma in HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome:
El Hajjami Ayoub1, Bouktib Youssef1, Badr Boutakioute1
1Radiology Department, Arrazi Hospital, Mohammed VI University Hospital, Cadi Ayyad University, Marrakesh, MAR.
HELLP syndrome is a severe obstetric complication characterized by hemolysis, elevated liver enzymes, and low platelet count, typically occurring in the third trimester or postpartum period. One of its rare but life-threatening complications is subcapsular hepatic hematoma, which may rupture and cause catastrophic hemorrhage. We report the case of a 38-year-old woman with type 2 diabetes mellitus who developed severe right upper quadrant pain three days after a cesarean delivery complicated by eclampsia. Laboratory findings were consistent with HELLP syndrome. Abdominal ultrasound and contrast-enhanced computed tomography (CT) revealed a right subcapsular hepatic hematoma measuring 34 mm in thickness, associated with hepatic infarctions and moderate ascites. Given the high risk of rupture, urgent transarterial embolization was performed via selective catheterization of the right hepatic artery using 400-micron microparticles, achieving complete hemostasis while preserving hepatic perfusion. The patient remained stable and recovered uneventfully, with gradual resolution of the hematoma and normalization of laboratory parameters, thereby avoiding surgical intervention. This case highlights the importance of early recognition and prompt interventional management of hepatic complications in HELLP syndrome. Transarterial embolization offers a minimally invasive, effective, and organ-preserving alternative to surgery in selected hemodynamically stable patients, underscoring the value of multidisciplinary collaboration among obstetric, critical care, and interventional radiology teams to optimize maternal outcomes.
HELLP syndrome is a severe obstetric complication characterized by hemolysis, elevated liver enzymes, and low platelet count, typically occurring in the third trimester or postpartum period. One of its rare but life-threatening complications is subcapsular hepatic hematoma, which may rupture and cause catastrophic hemorrhage. We report the case of a 38-year-old woman with type 2 diabetes mellitus who developed severe right upper quadrant pain three days after a cesarean delivery complicated by eclampsia. Laboratory findings were consistent with HELLP syndrome. Abdominal ultrasound and contrast-enhanced computed tomography (CT) revealed a right subcapsular hepatic hematoma measuring 34 mm in thickness, associated with hepatic infarctions and moderate ascites. Given the high risk of rupture, urgent transarterial embolization was performed via selective catheterization of the right hepatic artery using 400-micron microparticles, achieving complete hemostasis while preserving hepatic perfusion. The patient remained stable and recovered uneventfully, with gradual resolution of the hematoma and normalization of laboratory parameters, thereby avoiding surgical intervention. This case highlights the importance of early recognition and prompt interventional management of hepatic complications in HELLP syndrome. Transarterial embolization offers a minimally invasive, effective, and organ-preserving alternative to surgery in selected hemodynamically stable patients, underscoring the value of multidisciplinary collaboration among obstetric, critical care, and interventional radiology teams to optimize maternal outcomes.
