Subcapsular Liver Hematoma Associated with Preeclampsia: A Two-Case Series and Literature Review

Subcapsular liver hematoma (SLH) is a rare but potentially life-threatening complication of severe preeclampsia and HELLP syndrome. Diagnosis is often delayed because of nonspecific clinical manifestations, exposing affected patients to a high risk of maternal and fetal mortality. We report a two-case series of SLH occurring in patients managed for complicated preeclampsia. Clinical, biological, radiological, therapeutic, and outcome data were retrospectively analyzed and compared with findings from the literature. The first patient, a 30-year-old woman, developed severe HELLP syndrome with massive hepatic cytolysis, profound thrombocytopenia, and multiorgan failure. The diagnosis of SLH was confirmed by ultrasonography and computed tomography, revealing a 6 × 5 cm hematoma. Multidisciplinary conservative management resulted in a favorable outcome after a prolonged intensive care stay. The second patient, a 44-year-old woman admitted with hemorrhagic shock, was found intraoperatively to have a large hepatic subcapsular hematoma during an emergency cesarean section. Despite conservative surgical management with hepatic packing, the clinical course was rapidly fatal. These cases illustrate the clinical and prognostic heterogeneity of SLH in the setting of preeclampsia and HELLP syndrome. Prognosis is closely related to the timeliness of diagnosis, initial hemodynamic status, and prompt multidisciplinary management. SLH should be systematically considered in any preeclamptic patient presenting with atypical abdominal pain. Early imaging and individualized management may significantly improve maternal and fetal outcomes.