Spontaneous Hepatic Hemangioma Rupture in a Normotensive Twin Pregnancy: A Case Report

We report the case of a 36-year-old woman, at 28 weeks of twin pregnancy, with no history of gestational hypertensive disorders, admitted to the emergency department with intermittent chest and epigastric pain while hemodynamically stable. Upper abdominal ultrasound revealed free fluid in the abdominal cavity and hemangiomas in the right hepatic lobe. The patient subsequently developed a drop in hematimetric levels and underwent an emergency cesarean section, which confirmed intrauterine fetal demise of one twin and delivery of the surviving neonate. During subsequent exploratory laparotomy, rupture of the right hepatic lobe with a large capsular hematoma was detected, followed by hepatic packing, abdominal drainage, and reoperation after 48 hours, which achieved hemostatic control. Both the patient and the newborn were discharged after 40 days of hospitalization and were in good general condition after 4 months of follow-up. Due to its wide variability in clinical presentation, spontaneous hepatic rupture during pregnancy is often underdiagnosed, compromising clinical management and negatively impacting maternal-fetal survival. Early diagnosis and individualized management strategies, combined with an interdisciplinary approach, are crucial for optimal maternal and fetal outcomes.