Ruptured subcapsular hematoma of the liver due to pre‑eclampsia presenting as interstitial pregnancy and the role of intra‑abdominal packing

Abstract

Ruptured subcapsular hematoma of the liver (RSHL) can mimic ruptured interstitial pregnancy because each of these conditions occasionally presents at the same gestational period and both do manifest hemodynamic instability. The similarities between the two conditions pose a diagnostic challenge, especially in an unbooked patient. We report a case of an unbooked primigravida, at 21 weeks of gestation, who arrived at a regional hospital with evidence of intra‑abdominal bleeding and hypovolemic shock. She was diagnosed as potentially having a ruptured interstitial pregnancy. During the ensuing emergency laparotomy, RSHL was discovered, the area around the ruptured liver capsule was packed with large abdominal swabs, and the patient recovered. This case report illustrates the need to consider RSHL in patients presenting with features of ruptured interstitial pregnancy, as this will assist in the planning of intraoperative care. We also describe abdominal packing and highlight the need for this essential surgical intervention to be taught to doctors practising in low‑resource settings.

Key words: Abdominal packing, HELLP syndrome, interstitial pregnancy, liver hematoma, pre‑eclampsia, surgical training