Ruptured subcapsular liver hematoma: an atypical and life-threatening presentation of HELLP syndrome.

Ruptured subcapsular liver hematoma (SLH) is a rare and life-threatening complication of HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, often mimicking other obstetric emergencies. A 35-year-old gravida 5 para 3 at 36 weeks gestation presented with severe back pain and underwent emergency cesarean for suspected uterine rupture. Intraoperatively, a ruptured SLH was identified. The liver hemorrhage was managed with packing, an Evarrest Fibrin Sealant patch, and massive transfusion protocol (MTP). Postoperative labs confirmed HELLP syndrome. She was discharged on postoperative day eleven following multidisciplinary care. This case illustrates the diagnostic challenges and management complexity of SLH in the setting of HELLP syndrome. Prompt recognition, surgical control, and multidisciplinary coordination were crucial for a successful outcome.