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Spontaneous ruptured subcapsular liver hematoma associated with pregnancy. A case report
1Department of Obstetrics and Gynecology, Oakwood Hospital, Dearborn, Michigan, USA.
Background:
Spontaneous rupture of a subcapsular liver hematoma in pregnancy is a rare and potentially life-threatening complication of preeclampsia. The incidence is approximately 1 in 45,000 live births. The liver hematoma is often not suspected until it ruptures.
Case:
A 32-year-old female developed severe shoulder pain at 33 weeks' gestation while in the hospital with preeclampsia. Liver involvement was suspected, and cesarean delivery was performed. Over the first two postpartum days the patient had rising liver enzyme and falling hematocrit levels. A ruptured subcapsular liver hematoma was discovered at emergency laparotomy. Both mother and infant survived.
Conclusion:
A patient with a liver hematoma will usually experience right upper quadrant or epigastric pain. However, shoulder pain should also be regarded with suspicion in patients with preeclampsia.