HELLP syndrome complicated by hepatic rupture fierife Özlem Genç 1 , Yasemin Albak 1 , Gamze Sönmez 1 , Tahsin Takç› 1 , Savafl Karakufl 1 , Ali Yan›k 1 , Hüsnü Ça¤r› Genç 2 , Sinan Soylu 2 1 Department of Obstetrics and Gynecology Faculty of Medicine, Cumhuriyet University, Sivas, Turkey 2 Department of General Surgery Faculty of Medicine, Cumhuriyet University, Sivas, Turkey Introduction Subcapsular liver hematoma has been reported in less than 2% of pregnancies complicated by HELLP syn- drome (hemolysis, elevated liver enzymes, and low platelets). [1] Clinicians should be aware of this rare but life-threatening complication with a presenting symptom of right upper quadrant abdominal pain. [2,3] In this paper, we report a patient with spontaneous hepatic rupture without a history of sudden-onset upper abdominal pain. Case Report A 34-year-old woman, gravida 2, para 1, was admitted to our emergency room at 29 weeks of gestation. She had history of gestational diabetes in current pregnancy and Özet: Hepatik rüptür ile komplike olan HELLP sendromu Amaç: HELLP (hemoliz, yükselmifl karaci¤er enzimleri ve düflük trombosit) sendromu ile iliflkili spontan hepatik rüptür nadir görülse de, gebeli¤in hayat› tehdit eden bir komplikasyondur. Baflar›l› bir so- nuç için prognozun köfle tafl›, h›zl› tan› konulmas›d›r. Olgu: Gebeli¤inin 29. haftas›ndaki 34 yafl›nda kad›n hastada, sa¤ üst kadran a¤r›s› olmaks›z›n halsizlik semptomu olup HELLP sen- dromunun neden oldu¤u spontan hepatik rüptürü saptanan bir ol- gu sunuyoruz. Sonuç: Hipotansiyona ba¤l› halsizlik flikayetinde olan bir gebe varsa, do¤um uzman› hastada hepatik rüptür olup olmad›¤›n› kon- trol etmelidir. HELLP sendromundaki hepatik rüptür, halsizlik- ten flikayet eden gebelerde ay›r›c› tan› olarak düflünülmelidir. Bu, genellikle ani bafllang›çl› kar›n a¤r›s› ve buna efllik eden hipotansi- yona neden olur. Ancak bu olguda oldu¤u gibi, kar›n a¤r›s› olma- dan da ortaya ç›kabilir. Kanamay› kontrol alt›na almak için kara- ci¤erin geçici tampon uygulamas› ile destekleyici önlemleri de içe- ren disiplinleraras› bir cerrahi yaklafl›m baflar›l› sonuçlar sa¤laya- bilir. Anahtar sözcükler: HELLP sendromu, s›rad›fl› bulgu, hepatik rüptür. Correspondence: fierife Özlem Genç, MD. Department of Obstetrics and Gynecology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. e-mail: lavender87@hotmail.com Received: June 29, 2017; Accepted: July 28, 2017 Please cite this article as: Genç fiÖ, Albak Y, Sönmez G, Takç› T, Karakufl S, Yan›k A, Genç HÇ, Soylu S. HELLP syndrome complicated by hepatic rupture. Perinatal Journal 2017;25(2):87–89. ©2017 Perinatal Medicine Foundation Available online at: www.perinataljournal.com/20170252007 doi:10.2399/prn.17.0252007 QR (Quick Response) Code: Case Report Perinatal Journal 2017;25(2):87–89                                 Abstract Objective: Although spontaneous hepatic rupture associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syn- drome is rare, it is a life-threatening complication of pregnancy. The cornerstone of prognosis for successful outcome is its prompt diagnosis. Case: We report a case of 34-year-old female at 29 weeks of gesta- tion with spontaneous hepatic rupture caused by HELLP syndrome as a presenting symptom of weakness without right upper quadrant abdominal pain. Conclusion: If there is a pregnant woman who is complaining of weakness accompanying with hypotension, obstetrician should check the patient for the presence of hepatic rupture. Hepatic rupture in HELLP syndrome should be considered as a differential diagnosis in pregnant patients with the complaint of weakness. It usually causes sudden onset of abdominal pain and accompanying hypotension. But as in this case, it may present without abdominal pain. An interdisci- plinary surgical approach including supportive measures with the use of temporary packing of the liver to control the bleeding can result in successful outcome. Keywords: Atypical presentation, HELLP syndrome, hepatic rupture.