# Spontaneous Hepatic Hemangioma Rupture in a Normotensive Twin Pregnancy: A Case Report

## TL;DR

A 36-year-old woman experienced a rare spontaneous liver rupture during twin pregnancy, requiring emergency surgery and leading to the loss of one fetus.

## Contribution

This case highlights the underdiagnosed risk of hepatic rupture in normotensive twin pregnancies.

## Key findings

- Spontaneous hepatic rupture occurred in a normotensive twin pregnancy without gestational hypertension.
- Emergency cesarean section and laparotomy were necessary to manage the rupture and fetal demise.
- Interdisciplinary care improved maternal and fetal outcomes despite complications.

## Abstract

We report the case of a 36-year-old woman, at 28 weeks of twin pregnancy, with no history of gestational hypertensive disorders, admitted to the emergency department with intermittent chest and epigastric pain while hemodynamically stable. Upper abdominal ultrasound revealed free fluid in the abdominal cavity and hemangiomas in the right hepatic lobe. The patient subsequently developed a drop in hematimetric levels and underwent an emergency cesarean section, which confirmed intrauterine fetal demise of one twin and delivery of the surviving neonate. During subsequent exploratory laparotomy, rupture of the right hepatic lobe with a large capsular hematoma was detected, followed by hepatic packing, abdominal drainage, and reoperation after 48 hours, which achieved hemostatic control. Both the patient and the newborn were discharged after 40 days of hospitalization and were in good general condition after 4 months of follow-up.

Due to its wide variability in clinical presentation, spontaneous hepatic rupture during pregnancy is often underdiagnosed, compromising clinical management and negatively impacting maternal-fetal survival. Early diagnosis and individualized management strategies, combined with an interdisciplinary approach, are crucial for optimal maternal and fetal outcomes.