title: Perihepatic adhesions: an unusual complication of hemolysis, elevated liver enzymes and low platelet syndrome.
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.
authors.affiliation: Margot M Koeneman, Louis L Peeters, Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands.
authors.forename: Margot M
authors.initials: MM
authors.lastname: Koeneman
authors.affiliation: Margot M Koeneman, Louis L Peeters, Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands.
authors.forename: Ger H
authors.initials: GH
authors.lastname: Koek
authors.affiliation: Margot M Koeneman, Louis L Peeters, Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Bemelmans
authors.affiliation: Margot M Koeneman, Louis L Peeters, Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Peeters
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003964:Diaphragm / Q000473:pathology / Q000601:surgery; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis; D006406:Hematoma / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000473:pathology / Q000601:surgery; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D013997:Time Factors; D000267:Tissue Adhesions; D016896:Treatment Outcome
keywords: Adhesions; Haematoma; Hemolysis, elevated liver enzymes and low platelet syndrome; Liver; Long-term effects; Tissue