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  • Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

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Unusual association of diseases/symptoms
Case report
Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma
  1. Brittany Sanford1,
  2. Catherine Hoeppner2,
  3. Tammy Ju3,
  4. Brian K Theisen4,
  5. Anna BuAbbud2 and
  6. Jordan M Estroff3
  1. 1Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
  2. 2Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
  3. 3Department of Surgery, George Washington University, Washington, DC, USA
  4. 4Department of Pathology, George Washington University, Washington, DC, USA
  1. Correspondence to Dr Catherine Hoeppner; choeppner{at}gwu.edu

Abstract

Management of a ruptured hepatocellular adenoma during pregnancy is a rare and potentially life-threatening entity. Few case reports have described management of the pregnant patient who presents in haemorrhagic shock secondary to a ruptured liver adenoma. A 30-year-old primigravid woman at 31 weeks pregnant presented with abdominal pain and fetal bradycardia. After stat caesarean delivery of the infant, she had continued hemoperitoneum and was in shock secondary to an undiagnosed ruptured liver mass. General surgery was consulted intraoperatively and performed an exploratory laparotomy, packing and temporary closure. She was subsequently taken to interventional radiology (IR) for angioembolisation of the left hepatic artery. After stabilisation, she underwent formal abdominal closure. Management of a ruptured hepatocellular adenoma in pregnancy requires urgent multidisciplinary care including obstetrics gynaecology, general surgery and IR.

  • liver disease
  • pregnancy
  • interventional radiology
  • general surgery
  • adult intensive care

https://doi.org/10.1136/bcr-2019-231995

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    Footnotes

    • Contributors BS, CH, TJ, BKT, AB and JE were all central to the care of this patient described in the case report. They have all contributed to the writing and editing of the report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.