Managing Life-Threatening Spontaneous Liver Rupture in Pregnancy: A Case Study

Abstract

Objective: Rare disease Background: Spontaneous liver rupture during pregnancy is a rare but life-threatening condition with high maternal and perinatal mortality. It is commonly associated with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, preeclampsia, and liver-related diseases, making diagnosis and management challenging due to non-specific symptoms. Immediate intervention and a multidisciplinary approach are crucial for improving outcomes. Case Report: A 34-year-old primigravida woman at 35+5 weeks of gestation presented with severe epigastric pain, nausea, and vomiting. Initially treated for GERD, her symptoms persisted. Ultrasound revealed a fetus appropriate for gestational age (AGA) with normal well-being, amniotic fluid levels, and intact placental attachment. However, intra-abdominal visualization was limited due to advanced gestation and suspected bleeding around the uterus. As the patient’s condition deteriorated, emergency surgery was performed, revealing a large liver mass rupture with significant intra-abdominal bleeding. Perihepatic packing was used for stabilization. Subsequent imaging identified a subcapsular hematoma in hepatic segments 2/3. A second surgery was performed, and a lateral segmentectomy was completed. Both the mother and baby recovered well, with the Jackson-Pratt drain removed on postoperative day 3 and discharge on day 7. Conclusions: Spontaneous liver rupture, although rare, should be considered in pregnant patients with unexplained abdominal pain, even in the absence of typical risk factors. Early surgical intervention, timely imaging, and a multidisciplinary approach are critical for successful outcomes. Perihepatic packing serves as a lifesaving temporary measure to control bleeding and allow for further surgical planning.