Spontaneous subcapsular hepatic hematoma with hepatic rupture and hemorrhage in the postpartum period: a case report and literature review

Subcapsular hepatic hematoma with hepatic rupture in the postpartum period is a rare but potentially fatal condition, most commonly associated with hypertensive disorders of pregnancy and HELLP syndrome. In women without typical risk factors, non-specific symptoms may delay diagnosis. We report a previously healthy term primiparous woman who developed sudden, persistent right upper abdominal pain with nausea 3 h after vaginal delivery. On admission, she had right upper abdominal tenderness, tachycardia, and relative hypotension. Laboratory tests showed anemia, markedly elevated transaminases, and mild coagulation abnormalities. Contrast-enhanced CT demonstrated a large right-lobe subcapsular hepatic hematoma (14.8 × 12.4 cm) with hepatic parenchymal laceration and contrast extravasation, indicating active bleeding, together with perihepatic and abdominopelvic fluid. Emergency angiography confirmed multifocal bleeding from hepatic arterial branches with a hepatic artery–portal vein shunt, and superselective transcatheter arterial embolization achieved hemostasis. Because CT and pelvic angiography raised concern for a possible concurrent occult uterine arterial bleeding source, adjunct bilateral uterine artery embolization was performed in the same session. Recovery was uneventful, with progressive clinical and laboratory improvement. At 5-month follow-up, imaging showed marked hematoma resolution without rebleeding or related complications. This case highlights that persistent postpartum upper abdominal pain warrants early imaging evaluation even in the absence of typical HDP/HELLP-related risk factors. In selected patients with imaging evidence of active bleeding who remain suitable for urgent angiographic intervention, transcatheter arterial embolization may provide an effective minimally invasive hemostatic option.