Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 5042-5050
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.5042
Spontaneous liver rupture following SARS-CoV-2 infection in late pregnancy: A case report
Radek Ambrož, Martin Stašek, Ján Molnár, Petr Špička, Dušan Klos, Jozef Hambálek, Daniela Skanderová
Radek Ambrož, Martin Stašek, Ján Molnár, Petr Špička, Dušan Klos, Jozef Hambálek, Daniela Skanderová, Department of Surgery I, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University, Olomouc 77900, Czech Republic
Jozef Hambálek, Department of Obstetrics and Gynecology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University, Olomouc 77900, Czech Republic
Daniela Skanderová, Department of Pathology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University, Olomouc 77900, Czech Republic
Author contributions: Ambrož R was the attending physician, reviewed the literature and contributed to manuscript; Molnár J and Špička P reviewed the literature and consulted the histopathological findings; Klos D performed the surgery, and was responsible for supervising this article; Hambalek Josef performed the gynaecological part of the surgery, and was also the attending physician; Skanderová D provided histopathological findings including imaging material; all authors issued final approval for the version to be submitted.
Supported by the Ministry of Health, Czech Republic-conceptual Development of Research Organization, No. FNOl 00098892.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Martin Stašek, MD, PhD, Surgeon, Department of Surgery I, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University, 92/13 I.P. Pavlova, Nová Ulice, Olomouc 77900, Czech Republic. martin.stasek@fnol.cz
Received: December 2, 2021
Peer-review started: December 2, 2021
First decision: January 8, 2022
Revised: January 22, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 26, 2022
Processing time: 173 Days and 7.3 Hours
Abstract
BACKGROUND

Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by systemic inflammatory response syndrome and vasculopathy. SARS-CoV-2 associated mortality ranges from 2% to 6%. Liver dysfunction was observed in 14%-53% of COVID-19 cases, especially in moderate severe cases. However, no cases of spontaneous hepatic rupture in pregnant women with SARS-CoV-2 have been reported.

CASE SUMMARY

A 32-year-old pregnant patient (gestational age: 32 wk + 4 d) without any remarkable medical history or long-term medication presented with epigastralgia. Infectious, non-infectious, and pregnancy-related hepatopathies were excluded. Sudden onset of right subcostal pain with D-dimer and liver enzyme elevation was followed by shock with thrombocytopenia. While performing an emergency cesarean section, hemoperitoneum was observed, and the patient delivered a stillbirth. A 6-cm liver rupture at the edges of segments V and VI had occurred, which was sutured and drained. SARS-CoV-2 positivity on reverse transcription-polymerase chain reaction was confirmed. Further revisions for intrahepatic hematoma with hemorrhagic shock and abdominal compartment syndrome were performed. Subsequently, the patient developed hemoptysis, which was treated using bronchoscopic therapy and non-invasive ventilation. Liver tissue biopsy revealed hemorrhagic foci and necrosis with an irregular centrilobular distribution. Antiphospholipid syndrome and autoimmune hepatitis were also ruled out. Fetal death was caused by acute intrauterine asphyxia.

CONCLUSION

This case reveals that pregnant women with SARS-CoV-2 infection may be predisposed to liver parenchyma disease with liver rupture.

Keywords: Liver rupture; SARS-CoV-2; Pregnancy; Abortion; HELLP; Case report

Core Tip: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may contribute to the worsening of hepatopathy during pregnancy, because of its effect on the endothelium in the systemic inflammatory response syndrome microenvironment. Liver rupture causes high mortality in both the mother and fetus. Such a life-threatening scenario requires close collaboration between the obstetrician and the surgeon with an urgent indication for cesarean section, preferably by midline laparotomy with meticulous control of the liver and treatment of any injury. The presence of SARS-CoV-2 in pregnant women and its association with the development of severe hepatopathy in pregnancy requires further research.