LIVER-TRANSPLANT AFTER MASSIVE SPONTANEOUS HEPATIC RUPTURE IN PREGNANCY COMPLICATED BY PREECLAMPSIA

Background: Spontaneous hepatic rupture associated with preeclampsia i s a rare but life-threatening situation. Several different surgical tr eatments have been described, depending on the severity of the rupture . Liver transplantation has become the mainstay for patients with end- stage liver disease. Transplantation in the setting of liver trauma or massive parenchymal disruption is not well defined. To our knowledge, this treatment has not been reported for spontaneous hepatic rupture in pregnancy. Case: Massive, spontaneous hepatic rupture occurred in a patient at 36 weeks' gestation as a result of severe preeclampsia. Co nventional surgical therapies were unsuccessful in controlling the mas sive hemorrhage. As a life-saving measure, the patient underwent total hepatectomy with the creation of an end-to-side portacaval shunt, the reby rendering the patient anhepatic. The patient was listed as urgent ly needing a liver for transplantation through the United Network for Organ Sharing. A suitable donor liver was located approximately 8 hour s after the emergency hepatectomy. The patient underwent orthotopic li ver transplantation after being maintained in an anhepatic state for a lmost 13 hours. The patient was discharged on postoperative day 41, su ffering only from some ischemic lower extremity neuropathy secondary t o hypovolemic hypotension occurring during the hepatectomy procedure. Conclusion: In the reported case, spontaneous hepatic rupture resulted in a massive hemorrhage that could not be controlled by previously re ported techniques and required total hepatectomy followed by liver tra nsplantation.