緊急帝王切開時に診断した肝臓を出血源とするSHiPの一例

The paper presents a case report of spontaneous hemoperitoneum in pregnancy (SHiP) in a 28-year-old woman managed for chronic hypertension, with evaluation driven by possible early HELLP syndrome based on rising blood pressure, recurrent vomiting, fetal growth restriction, a high sFlt-1/PlGF ratio, subtle liver enzyme elevation, and abnormal fetal monitoring, culminating in an emergency cesarean section. During surgery, hemoperitoneum was identified after peritoneal entry, but no pelvic source was found; intraoperative assessment by surgical consultation determined the bleeding to originate from the liver surface, and焼灼止血術 with topical hemostatic agents achieved hemostasis, with postoperative imaging showing a large hepatic hematoma without contrast leak. The authors note that preoperative diagnosis of SHiP is difficult and that their differential included HELLP-related hepatic subcapsular rupture, yet they concluded the intraoperative findings and atypical course supported SHiP. Relevance to endometriosis: the introduction and discussion cite endometriosis as a proposed risk factor/associated condition in SHiP and discuss Japanese data on typical bleeding sources, though this specific case involved liver surface bleeding without reported endometriosis history, so the paper relates to endometriosis as background context for SHiP rather than as the cause in this patient.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works