Successful Packing of Hepatic Hematoma Rupture Following Preeclampsia: A Case Report (Running Title: Hepatic Hematoma and Preeclampsia)

Introduction: Hepatic hematoma rupture following preeclampsia is a rare finding in the postpartum. Diagnosis of this critical condition requires a high index of suspicion. Many other clinical conditions may also complicate the diagnosis and mask the hemorrhage.Case Report: We presented a case of hepatic hematoma rupture in the postpartum period in a patient with preeclampsia. After a successful cesarean section, the patient experienced gradual hypotension and underwent bedside ultrasonography due to the rapid decrease of fetal heart rate in the setting of preeclampsia. Free fluid was prominent, and due to gallbladder stones, dilated bile duct, and high body mass index, only a small, suspicious mass was visualized in the liver. In the operating room, hysterectomy was performed due to free blood within the abdominal cavity, uterine inertia, and hematoma in the broad ligament and bladder. However, hemorrhage started again from the abdominal drains one hour after hysterectomy. After examining the entire abdomen, a bleeding hematoma was observed on the inner site of the liver and packed successfully. Two days after packing, gauzes were removed from the abdomen, and the patient was discharged in good condition four days later without any complications in the follow-up visits.Conclusion: Ruptured hepatic hematoma requires immediate management and close follow-up. Gynecologists and surgeons should consider that simple surgical techniques, such as packing, could be applicable in hepatic bleeding hematomas if further hemodynamic monitoring and experienced surgeons are available.

Keywords:

Preeclampsia , Pregnancy , Hematoma , Hysterectomy