Key Clinical MessageHELLP syndrome is a complicated disorder associated with many unknown complications, which ischemic colitis might be one of. Timely diagnosis and prompt management with multidisciplinary approach is the key for a favorable outcome.AbstractHELLP syndrome is a triad of hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) which is considered a rare but serious pregnancy complication. HELLP syndrome is mainly associated with pre‐eclampsia, but can also occur individually. It may cause maternal and fetal mortality and some life‐threatening morbidity. The best management considered for HELLP syndrome is immediate delivery in most cases. We report a 32‐week pregnant woman with pre‐eclampsia who developed HELLP syndrome shortly after admission which led to a preterm cesarean section. Rectal bleeding and diarrhea started the day after delivery, and all the workups and imaging suggested ischemic colitis. She received intensive care and supportive management. The patient recovered and was discharged uneventfully. HELLP syndrome may be associated with many unknown complications, and ischemic colitis might be one of them. Timely diagnosis and prompt management with a multidisciplinary approach is the key to a favorable outcome.