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Subkapsularës leberhämatom bei HELLP-syndrom

Subcapsular liver hematoma with HELLP-syndrome — an interdisciplinary urgency

Ein interdisziplinärer notfall

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Summary

The HELLP-syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), known as a complication during pregnancy, is associated with preeclampsia and may cause subcapsular liver hematomas. In case of hepatic rupture the lives of mother and unborn are threatened. Therefore, an interdisciplinary diagnostic and therapeutic approach is discussed and compared to two examples. The diagnosis of subcapsular liver hematoma must lead to urgent delivery through Cesarean section. Thereafter, the surgeon may decide between observation on an intensive care unit and urgent operation in case of hepatic rupture, without endangering the unborn.

Zusammenfassung

Das HELLP-Syndrom (Hemolysis, Elevated Liver enzymes, Low Platelets) tritt als Komplikation einer Schwangerschaftspräeklampsie auf und kann zu ausgedehnten subkapsulären Leberhämatomen führen. Wegen der Rupturgefahr der Hämatome besteht eine lebensbedrohende Notfallsituation für Mutter und Ungeborenes. Anhand von 2 Fallbeispielen wird das interdisziplinäre Vorgehen diskutiert. Mit Diagnosestellung der subkapsulären Leberhämatome sollte die notfallmäßige Entbindung durch Sectio erfolgen. Dann kann die chirurgische Entscheidung für eine konservative, abwartende Therapie mit Intensivüberwachung oder für eine Notfalloperation im Falle einer Leberkapselruptur ohne vermeidbares Risiko getroffen werden.

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Literatur

  1. Abercrombie J (1844) Case of hemorrhage of liver. Lond Med Gaz 34:792–794

    Google Scholar 

  2. Benacerraf BR, Frigoletto FD, Martini CA (1985) Sonographic findings in severe preeclampsia twentyfour hours prior to clinical signs. Am J Obstet Gynecol 152:684–686

    Google Scholar 

  3. Bis KA, Waxman B (1976) Rupture of liver associated with pregnancy: a review of the literature and a report of two cases. Obstet Gynecol Surv 31:763–773

    Google Scholar 

  4. Friedman SA (1988) Preeclampsia: a review of the roles of prostaglandins. Obstet Gynecol 71:122–137

    Google Scholar 

  5. Henny CP, Lim AE, Brummelkamp WH, Buller HR, Ten Cate JW (1983) A review of the importance of acute multidisciplinary treatment following spontaneous rupture of the liver capsule during pregnancy. Surg Gynecol Obstet 156:593–598

    Google Scholar 

  6. Hüskes KP, Baumgartner A, Hardt U, Klink F (1991) Doppelseitige, mehrzeitige Spontanruptur der Leber bei HELLP-Syndrom. Chirurg 62:221–222

    Google Scholar 

  7. Manas KJ, Welsh JD, Rankin RA, Miller DD (1985) Hepatic hemorrhage without rupture in preeclampsia. N Engl J Med 312:424–426

    Google Scholar 

  8. Neerhof MG, Zelman W, Sullivan T (1989) Hepatic rupture in pregnancy. Obstet Gynecol Surv 44:407–409

    Google Scholar 

  9. Nelson EW, Archibald L, Albo D (1977) Spontaneous hepatic rupture in pregnancy. Am J Surg 134:817–820

    Google Scholar 

  10. Öney T, Weitzel H (1990) Komplikative Lebererkrankungen in der Schwangerschaft. Z Geburtshilfe Perinatol 194:145–152

    Google Scholar 

  11. Pratschke E, Koebe G, Hofmann GO, Schildberg FW (1991) Chirurgische Therapie von Leberverletzungen nach stumpfem Bauchtrauma. Aktuel Chir 26:22–25

    Google Scholar 

  12. Rath W, Loos W, Kuhn W, Graeff H (1988) Die Bedeutung der frühzeitigen Labordiagnostik für das geburtshilfliche Vorgehen bei schweren Gestosen und HELLP-Syndrom. Geburtshilfe Frauenheilkd 48:127–133

    Google Scholar 

  13. Rolfes DB, Ishak KG (1986) Liver disease in toxemia of pregnancy. Am J Gastroenterol 81:1138–1144

    Google Scholar 

  14. Sibai BM, Taslimi MM, El-Nazer A, Amon E, Mabie BC, Ryan GM (1986) Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia. Am J Obstet Gynecol 155:501–509

    Google Scholar 

  15. Walsh SW (1985) Preeclampsia: an imbalance in placental prostacyclin and thromboxane production. Am J Obstet Gynecol 152:335–340

    Google Scholar 

  16. Weinstein L (1982) Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 142:159–167

    Google Scholar 

  17. Weinstein L (1985) Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia. Obstet Gynecol 66:657–664

    Google Scholar 

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Authors and Affiliations

  1. Chirurgische Klinik and Poliklinik, Ludwig-Maximilians-Universität, Marchioninistraße 15, W-8000, München 70, Germany

    W. -A. Cappeller, H. Stiegler, L. Sunder-Plassmann & E. Pratschke

  2. Frauenklinik, Ludwig-Maximilians-Universität, Marchioninistraße 15, W-8000, München 70, Germany

    R. Knitza

  3. Institut für Andsthesiologie, Ludwig-Maximilians-Universität, Marchioninistraße 15, W-8000, München 70, Germany

    J. Briegel & H. Forst

Authors
  1. W. -A. Cappeller
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  2. R. Knitza
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  3. J. Briegel
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  4. H. Forst
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  5. H. Stiegler
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  6. L. Sunder-Plassmann
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  7. E. Pratschke
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Cappeller, W.A., Knitza, R., Briegel, J. et al. Subkapsularës leberhämatom bei HELLP-syndrom. Langenbecks Arch Chir 377, 100–103 (1992). https://doi.org/10.1007/BF00184343

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  • DOI: https://doi.org/10.1007/BF00184343

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