Subcapsular hepatic hematoma with hepatic rupture in the postpartum period is a rare but potentially fatal condition, most commonly associated with hypertensive disorders of pregnancy and HELLP syndrome. In women without typical risk factors, non-specific symptoms may delay diagnosis. We report a previously healthy term primiparous woman who developed sudden, persistent right upper abdominal pain with nausea 3 h after vaginal delivery. On admission, she had right upper abdominal tenderness, tachycardia, and relative hypotension. Laboratory tests showed anemia, markedly elevated transaminases, and mild coagulation abnormalities. Contrast-enhanced CT demonstrated a large right-lobe subcapsular hepatic hematoma (14.8 × 12.4 cm) with hepatic parenchymal laceration and contrast extravasation, indicating active bleeding, together with perihepatic and abdominopelvic fluid. Emergency angiography confirmed multifocal bleeding from hepatic arterial branches with a hepatic artery–portal vein shunt, and superselective transcatheter arterial embolization achieved hemostasis. Because CT and pelvic angiography raised concern for a possible concurrent occult uterine arterial bleeding source, adjunct bilateral uterine artery embolization was performed in the same session. Recovery was uneventful, with progressive clinical and laboratory improvement. At 5-month follow-up, imaging showed marked hematoma resolution without rebleeding or related complications. This case highlights that persistent postpartum upper abdominal pain warrants early imaging evaluation even in the absence of typical HDP/HELLP-related risk factors. In selected patients with imaging evidence of active bleeding who remain suitable for urgent angiographic intervention, transcatheter arterial embolization may provide an effective minimally invasive hemostatic option.
Liu et al. (Mon,) studied this question.
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