Manifestes Multiorganversagen ist der dramatische Endpunkt der schwersten Verlaufsform des HELLP-Syndroms (hemolysis, elevated liver function, low platelets). Spezifische Therapiestategien sind noch nicht routinemässig geklärt. Wir präsentieren die Kasuistik einer kombinierten chirugischen Therapie (Hepatektomie, portokavale Anastomose, orthotope Lebertransplantation). Eine 26-jährige Primapara entwickelte post partum (39.SSW) eine Leberruptur bei HELLP-Syndrom. Notfallmässige Hepatektomie und portokavale Anastomose waren eine suffiziente Überbrückung bis zur Lebertransplantation. Die Patientin konnte bei komplikationslosem Verlauf nach Lebertransplantation bei exzellenter Organfunktion frühzeitig entlassen werden. Der portokavale Shunt und die Lebertransplantation repräsentierten für unsere Patientin eine effektive Therapie. Eine aggressive chirurgische Therapie sollte als frühe Option der Behandlung der Leberruptur bei HELLP-Syndrom in Erwägung gezogen werden.

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