A Case of Hepatic Rupture Associated with a Right-sided Round Ligament Related to Partial Hellp Syndrome

Abstract

A 37-year-old woman who underwent emergency cesarean section for a progressive severe hypertensive disorder of pregnancy with dichorionic diamniotic twins was referred to our department. She was diagnosed as having partial HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome because of severe elevations of liver enzyme levels. Computed tomography for postoperative intraabdominal hemorrhage showed hepatic rupture and a massive subcapsular liver hematoma associated with a right-sided round ligament. Hemostasis for active arterial bleeding by transcatheter arterial embolization (TAE) rescued the patient, but the right liver infarcted. Therefore, she underwent resection of the right lateral sector and dorsal part of the right paramedian sector of the liver 10 days after the TAE procedure. The sequential strategy of emergency TAE and elective hepatectomy with a rare anatomical anomaly to manage hepatic rupture associated with a severe peripartum complication is reported.