Pregnant-Postpartum Women with Severe Epigastric Pain and HELLP Syndrome: A Highly Dangerous Combination

Objective Thrombotic thrombocytopenic purpura is a thrombotic microangiopathic condition characterized by hemolytic anemia, thrombocytopenia, neurologic abnormalities, fever and renal dysfunction. Thrombotic microangiopathies such as preeclampsia and HELLP syndrome are pregnancy-specific, whereas others such as thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome are not. In this report, we present a case at which we identified a novel mutation which led to a significant reduction of ADAMTS13 activity. Case(s) A nulliparous pregnant woman of 32-year-old presenting with epigastric pain, hypertension and low platelet count was first suspected of HELLP syndrome, but was diagnosed with congenital TTP after delivery. Conclusion HELLP syndrome co-existed with undiagnosed TTP in this case. We strive to have sufficient awareness in order to distinguish these two pathologies from each other on an antenatal basis, because the causes of the managements are entirely different.

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Postpartum Spontaneous Subcapsular Hepatic Hematoma Related to Preeclampsia

Case Reports in Emergency Medicine ◽

10.1155/2014/417406 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Dimitrios Anyfantakis ◽

Miltiades Kastanakis ◽

Georgios Fragiadakis ◽

Paraskevi Karona ◽

Nikolaos Katsougris ◽

...

Keyword(s):

Epigastric Pain ◽

Emergency Caesarean Section ◽

Maternity Ward ◽

Hepatic Hematoma ◽

Pregnancy And Postpartum ◽

Life Threatening ◽

Clinical Phenomenon ◽

Diagnostic Work ◽

Work Up ◽

Severe Epigastric Pain

Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency department of our institution complaining of severe epigastric pain. Diagnostic work-up was suggestive of a subcapsular right lob hepatic hematoma which was successfully managed conservatively. Timely diagnosis is necessary for the prevention of life-threatening events in mother and fetus. For this reason acute care physicians have to be vigilant of the condition and consider this in the differential diagnosis of epigastric pain during pregnancy and postpartum.

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An Uncommon Cause of Severe Epigastric Pain with Multiple Intestinal Ulcers after Renal Transplantation- Strongyloides Hyperinfection

Transplantation Journal ◽

10.1097/00007890-201211271-01030 ◽

2012 ◽

Vol 94 (10S) ◽

pp. 535

Author(s):

D. Madhav ◽

K. P. Kumar

Keyword(s):

Renal Transplantation ◽

Epigastric Pain ◽

Intestinal Ulcers ◽

Severe Epigastric Pain

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Hiatal Hernia as a Total Gastrectomy Complication

Case Reports in Oncology ◽

10.1159/000443633 ◽

2016 ◽

Vol 9 (1) ◽

pp. 100-105 ◽

Cited By ~ 5

Author(s):

Bruna do Nascimento Santos ◽

Marcos Belotto de Oliveira ◽

Renata D'Alpino Peixoto

Keyword(s):

Hiatal Hernia ◽

Gastric Adenocarcinoma ◽

Epigastric Pain ◽

Abdominal Cavity ◽

Esophageal Hiatus ◽

The Third ◽

Esophageal Anastomosis ◽

Folfox Chemotherapy ◽

Laparoscopic Assisted ◽

Severe Epigastric Pain

Introduction: According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. Case Report: A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Conclusion: Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.

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Severe Epigastric Pain with Nausea and Vomiting

Surgery ◽

10.1007/978-3-030-05387-1_20 ◽

2019 ◽

pp. 227-237

Author(s):

Areg Grigorian ◽

Matthew Y. C. Lin ◽

Christian de Virgilio

Keyword(s):

Epigastric Pain ◽

Nausea And Vomiting ◽

Severe Epigastric Pain

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A rare case of COVID-19 related stomach gangrene after an abortion: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20211327 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1360

Author(s):

Komal Gupta ◽

Gopal Puri ◽

Jnaneshwari Jayaram ◽

Muhammed Huzaifa ◽

Kamal Kataria

Keyword(s):

Epigastric Pain ◽

Subtotal Gastrectomy ◽

Abdominal Distension ◽

Posterior Wall ◽

Emergency Laparotomy ◽

Rt Pcr ◽

Missed Abortion ◽

Medical Termination ◽

Arterial Thrombus ◽

Severe Epigastric Pain

A 25 year old female had presented with complaints of severe epigastric pain with abdominal distension and vomiting for 4 days. She had undergone medical termination of pregnancy for a missed abortion of 5 weeks of gestation 5 days prior. The patient's COVID-19 RT PCR was found to be positive. Her CECT showed covid related changes in bilateral lungs and pneumoperitoneum. Stomach was distended. Other small bowels appeared normal. Patient underwent emergency laparotomy. Two third of stomach appeared gangrenous with a perforation in the posterior wall of stomach so she underwent a subtotal gastrectomy. She had features of covid associated coagulopathy (CAC) with high D-dimer (520 ng/ml), thrombocytosis (up to 705,000/mcl), high activated partial thromboplastin time (aPTT) (up to 55.6 sec) and high prothrombin time (PT) (up to 27.9 sec and INR 2.11) for which low molecular heparin was given. Stomach is a highly vascular organ. Gangrene of the stomach has been very rarely reported. CAC is known to lead to both arterial thrombus and venous thromboembolism. COVID-19 related abortions have also been reported though the exact mechanism not certain but CAC could be one of them.

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Gastric intramural hematoma accompanied by severe epigastric pain and hematemesis after endoscopic mucosal resection

World Journal of Gastroenterology ◽

10.3748/wjg.v18.i47.7127 ◽

2012 ◽

Vol 18 (47) ◽

pp. 7127 ◽

Cited By ~ 9

Author(s):

Peng Sun

Keyword(s):

Endoscopic Mucosal Resection ◽

Epigastric Pain ◽

Intramural Hematoma ◽

Mucosal Resection ◽

Severe Epigastric Pain

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Effects of high-dose dexamethasone in postpartum women with class 1 haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome

Journal of Obstetrics and Gynaecology ◽

10.1080/01443615.2018.1525609 ◽

2018 ◽

Vol 39 (3) ◽

pp. 335-339 ◽

Cited By ~ 1

Author(s):

Akimasa Takahashi ◽

Nobuyuki Kita ◽

Yuji Tanaka ◽

Shunichiro Tsuji ◽

Tetsuo One ◽

...

Keyword(s):

Hellp Syndrome ◽

Liver Enzymes ◽

Postpartum Women ◽

High Dose ◽

High Dose Dexamethasone ◽

Elevated Liver Enzymes ◽

Class 1

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Pregnancy Outcome in Impaired Liver Function in Pre-eclampsia

Bangladesh Medical Journal ◽

10.3329/bmj.v49i2.55813 ◽

2020 ◽

Vol 49 (2) ◽

pp. 9-13

Author(s):

Amina Khatun ◽

Abul Masud Md Nurul Karim ◽

Aslam Hossain Biswas ◽

Md Tarique Mehedi Parvez

Keyword(s):

Liver Function ◽

Pregnancy Outcome ◽

Liver Enzyme ◽

Hellp Syndrome ◽

Liver Enzymes ◽

Elevated Liver Enzyme ◽

Epigastric Pain ◽

Clinical Severity ◽

Third Trimester ◽

Major Complications

Pre-eclampsia induced liver disease is a disorder unique to pregnancy and is frequently seen in third trimester. Severe pre-eclampsia is defined by extreme elevation in systemic blood pressure and evidence of organ compromise. HELLP syndrome is a unique liver related disorder of pregnancy that was first described by Weinstein in1982 as a constellation of clinical and laboratory abnormalities in pregnant women in their third trimester. This disorder was termed HELLP syndrome with (H) for haemolysis, (EL) for elevated liver enzymes and (LP) for low platelet counts. This is a severe variant of pre-eclampsia. Objective of this study was to determine the alteration of liver function in preeclampsia and its correlation with the clinical severity as well as the perinatal outcome. This was a one-year prospective observational cross sectional study included 100 patients with pre-eclampsia. Severity of the pre-eclampsia clarified clinically. Pre-eclampsia patients having history of hepatitis, cirrhosis of liver, gallbladder diseases and other pre-existing medical disorders that altered liver function were excluded from this study. The mean age of the patients was 25.3+4.9 years ranging from 18 to 37 years. One third of the patients (33.3%) were in the age group 28 to 32 years. Out of 100 patients, 58% belongs to poor income group. Among the studied samples 17% had epigastric pain and discomfort, 13% had complaints of vomiting and 43% develop severe pre-eclampsia. Among the Patients with altered hepatic enzyme level, 8.33% had complaints of epigastric pain, 6.66% complains vomiting. Maximum patients (66.6%) with elevated liver enzyme had no major complications whereas 33.4% of patients developed major complications. Patients with severe pre-eclampsia have elevated liver enzyme whereas patients of mild symptoms had normal liver enzymes level. Cases with raised serum biochemical markers had strong association with complications of severe pre-eclampsia. Pregnancy outcome in severe pre-eclampsia with hepatic involvement is grievous. Graves sequlae of pre-eclampsia can be prevented and minimized by timely institutional intervention. Post-partum followup would help to find out other parameters of pregnancy outcome. Bangladesh Med J. 2020 May; 49(2) : 9-13

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Pregnancy-Associated Hemolysis, Elevated Liver Functions, Low Platelets (HELLP) Syndrome: An Obstetric Disease in the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/088506669601100304 ◽

1996 ◽

Vol 11 (3) ◽

pp. 173-178

Author(s):

George Gilson ◽

Pamela Golden ◽

Luis Izquierdo ◽

Luis Curet

Keyword(s):

Perinatal Mortality ◽

Hellp Syndrome ◽

Medical Condition ◽

Epigastric Pain ◽

Retrospective Chart Review ◽

Signs And Symptoms ◽

Maternal Complications ◽

Diagnostic Features ◽

Clinical Series ◽

Liver Functions

We reviewed the experience with hemolysis, elevated liver functions, low platelets (HELLP) syndrome at the University of New Mexico Hospital over the past 10 years to delineate the epidemiology and the clinical course of the disease. A retrospective chart review of a large, university-based, largely indigent, pregnant population was undertaken with attention to diagnostic features of the syndrome and maternal and infant outcomes of affected pregnancies. Comparisons were made with other large reported clinical series. Preeclampsia complicated 5.6% of deliveries in this study, and the HELLP syndrome occurred in 116 patients (0.3% of all deliveries). Epigastric pain, nausea, vomiting, and malaise usually heralded the syndrome. Signs and symptoms of preeclampsia (e.g., hypertension, proteinuria, and edema) were most often not striking at the time of presentation. The mean platelet count at diagnosis was 60 ± 25 × 103. Initial signs of hemolysis were usually minimal, although the hematocrit decreased a mean of 11.5 ± 5 vol% over the course of the disease. Moderate elevations of hepatic enzyme levels, specifically lactic dehydrogenase, were common; hyperbilirubinemia was usually mild and late. Maternal complications included disseminated intravascular coagulation, eclampsia, pulmonary edema, adult respiratory distress syndrome, and hepatic hematoma. Eight stillbirths and 7 neonatal deaths occurred (perinatal mortality, 126/1,000). HELLP syndrome is a relatively infrequent but serious development in the evolution of preeclampsia/eclampsia. Variations in onset and severity of hemolysis, hepatic dysfunction, and thrombocytopenia are common. Maternal complications and the perinatal mortality rate are high. Pregnant patients with right upper quadrant or epigastric pain and thrombocytopenia, even in the absence of significant hypertension and proteinuria, are most likely to have HELLP syndrome, rather than some other medical condition. Awareness of the variable presentations of this syndrome permit the prompt recognition and management necessary to optimize maternal and neonatal outcomes.

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