Hepatic rupture complicating HELLP syndrome in a low-resource setting: a case report

Spontaneous hepatic rupture is a rare but life-threatening complication of Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, associated with high maternal and perinatal mortality. Its diagnosis is challenging due to a nonspecific clinical presentation and limited diagnostic resources in low-resource settings. We report a 35-year-old woman who claims 7 months of amenorrhea with the diagnosis of severe preeclampsia and HELLP syndrome, who developed sudden right upper quadrant pain and hemodynamic instability. The bedside ultrasound showed hemoperitoneum and a ruptured subcapsular hematoma. Emergency laparotomy confirmed hepatic rupture, and hemostasis was achieved with surgical intervention. This case highlights the importance of maintaining a high index of suspicion for hepatic rupture in patients with HELLP syndrome presenting with acute abdominal pain. Timely diagnosis and surgical management are critical to improving maternal outcomes.