HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets)-Associated Subcapsular Hepatic Hematoma Presenting as Postoperative Hemorrhagic Shock: A Case Report
- 1Obstetrics and Gynecology, Universidade Santo Amaro, São Paulo, BRA
- 2Obstetrics and Gynecology, Universidade de São Paulo, São Paulo, BRA
- 3Research, Universidade de Mogi das Cruzes, São Paulo, BRA
Abstract
Subcapsular hepatic hematoma is a rare and life-threatening complication of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome associated with substantial maternal morbidity and mortality. We report the case of a 23-year-old primigravida at 27 weeks and 3 days of gestation who presented with severe frontal headache, nausea, vomiting, and hypertension and was initially diagnosed with preeclampsia with severe features. On hospital day three, clinical deterioration prompted emergency cesarean delivery, and postoperative laboratory findings confirmed HELLP syndrome. On the first postoperative day, the patient developed hypovolemic shock and signs of acute abdomen. Point-of-care ultrasonography revealed free intra-abdominal fluid, prompting urgent surgical re-exploration. An extensive subcapsular hepatic hematoma with active bleeding was identified, and damage control surgery with hepatic packing and temporary abdominal closure was performed. After 48 hours of clinical stabilization, planned re-exploration with pack removal and definitive abdominal wall closure was completed. Liver enzymes subsequently showed progressive normalization through hospital discharge. This case highlights the importance of recognizing hepatic complications of HELLP syndrome in patients with abrupt postoperative deterioration and demonstrates the role of coordinated multidisciplinary management in severe hemorrhagic presentations. In hemodynamically unstable patients with evidence of ongoing intra-abdominal hemorrhage, the absence of definitive cross-sectional imaging may not preclude urgent surgical exploration.
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BibTeX
@article{diaz2026hellp,
title = {{HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets)-Associated Subcapsular Hepatic Hematoma Presenting as Postoperative Hemorrhagic Shock: A Case Report}},
author = {Julia Grossi Diaz and Karolyne Vale de Sá and Sarah Tanios Daneluzzi and Beatriz Saddi Nascimento Cavalcante Peres and Ana Clara Mazzetti and Beatriz Nascimento Motta Spaleta and Fernando Casella Szuster and Julia C Monteiro Klock},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.118908},
url = {https://europepmc.org/article/PMC/PMC13723348},
note = {CC BY},
}
RIS
TY - JOUR
TI - HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets)-Associated Subcapsular Hepatic Hematoma Presenting as Postoperative Hemorrhagic Shock: A Case Report
AU - Julia Grossi Diaz
AU - Karolyne Vale de Sá
AU - Sarah Tanios Daneluzzi
AU - Beatriz Saddi Nascimento Cavalcante Peres
AU - Ana Clara Mazzetti
AU - Beatriz Nascimento Motta Spaleta
AU - Fernando Casella Szuster
AU - Julia C Monteiro Klock
PY - 2026
DA - 2026/10/31
JO - Cureus
DO - 10.7759/cureus.118908
UR - https://europepmc.org/article/PMC/PMC13723348
AB - Subcapsular hepatic hematoma is a rare and life-threatening complication of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome associated with substantial maternal morbidity and mortality. We report the case of a 23-year-old primigravida at 27 weeks and 3 days of gestation who presented with severe frontal headache, nausea, vomiting, and hypertension and was initially diagnosed with preeclampsia with severe features. On hospital day three, clinical deterioration prompted emergency cesarean delivery, and postoperative laboratory findings confirmed HELLP syndrome. On the first postoperative day, the patient developed hypovolemic shock and signs of acute abdomen. Point-of-care ultrasonography revealed free intra-abdominal fluid, prompting urgent surgical re-exploration. An extensive subcapsular hepatic hematoma with active bleeding was identified, and damage control surgery with hepatic packing and temporary abdominal closure was performed. After 48 hours of clinical stabilization, planned re-exploration with pack removal and definitive abdominal wall closure was completed. Liver enzymes subsequently showed progressive normalization through hospital discharge. This case highlights the importance of recognizing hepatic complications of HELLP syndrome in patients with abrupt postoperative deterioration and demonstrates the role of coordinated multidisciplinary management in severe hemorrhagic presentations. In hemodynamically unstable patients with evidence of ongoing intra-abdominal hemorrhage, the absence of definitive cross-sectional imaging may not preclude urgent surgical exploration.
SN - 2168-8184
ER -