Case Report
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World J Gastroenterol. Jul 14, 2014; 20(26): 8726-8728
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8726
Perihepatic adhesions: An unusual complication of hemolysis, elevated liver enzymes and low platelet syndrome
Margot M Koeneman, Ger H Koek, Marc Bemelmans, Louis L Peeters
Margot M Koeneman, Louis L Peeters, Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
Ger H Koek, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
Marc Bemelmans, Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
Author contributions: Koek GH, Bemelmans M and Peeters LL were the treating physicians; Koeneman MM drafted the manuscript; Koek GH and Peeters LL reviewed the manuscript; all authors performed data collection and contributed to approve of the final version of the manuscript.
Correspondence to: Margot M Koeneman, MD, Department of Obstetrics and Gynecology, Maastricht University Medical Center, Postbus 5800, 6202 AZ Maastricht, The Netherlands. m.koeneman@alumni.maastrichtuniversity.nl
Telephone: +31-6-26636694 Fax: +31-43-3875006
Received: August 13, 2013
Revised: November 15, 2013
Accepted: January 6, 2014
Published online: July 14, 2014
Processing time: 343 Days and 20.3 Hours
Abstract

We present a case of symptomatic perihepatic adhesions, which developed after a pregnancy complicated by hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome, in which a subcapsular liver hematoma occurred. Our patient presented with complaints of persistent, severe right-sided upper abdominal pain. The complaints developed gradually, one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma. The hematoma had resolved spontaneously. An upper-abdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma, suspect of perihepatic adhesions. The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session. The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment. This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.

Keywords: Hemolysis, elevated liver enzymes and low platelet syndrome; Liver; Haematoma; Long-term effects; Adhesions; Tissue

Core tip: This case of perihepatic adhesions may be the first presentation of a long term sequel of subcapsular liver hematoma in hemolysis, elevated liver enzymes and low platelet syndrome, which occured in pregnancy.