Document Type: Case report
Department of Obstetrics and Gynecology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Department of Anesthesiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Introduction: Rupture of hepatic hematoma following preeclampsia in postpartum period is a rare finding. Diagnosis of this critical condition requires high index of suspicion. Many other clinical conditions can make the diagnosis more complicated and mask the hemorrhage.
Case presentation: In present report we will discuss a case of hepatic hematoma rupture in postpartum period of a patient with preeclampsia. After a successful cesarean section because of rapid decrease of fetal heart rate in the settings of preeclampsia, the patient experienced gradual hypotension and underwent bedside ultrasonography. Free fluid was prominent and because of gallbladder stones, dilated biliary ducts and high body mass index, only a suspicious small mass was visualized on the liver. In the operating room because of free blood within abdominal cavity, uterine inertia and hematoma in the broad ligament as well as bladder, a hysterectomy was performed. However, the bleeding started again an hour after hysterectomy from abdominal drains. After exploring the entire abdomen, a bleeding hematoma on the inner site of liver was visualized and packed successfully. Two days after packing, the gazes were removed from the abdomen and the patient discharged healthy 4 days later without any complications in her follow up visits.
Conclusion: Ruptured hepatic hematoma requires immediate management and close follow up. Gynecologists and surgeons should keep in mind that simple surgical techniques such as packing can be applicable in hepatic bleeding hematomas if further hemodynamic monitoring and well experienced surgeons are available.