Focal hemorrhagic necrosis of the liver. A clinicopathological entity possibly related to oral contraceptives

A 44-year-old woman who had been taking oral contraceptives for 10 yr developed abdominal pain and abnormalities of liver tests, which led to the discovery of multiple filling defects on liver scan and of large hepatic zones of decreased density on computerized tomography of the abdomen. These abnormalities were due to sharply demarcated areas of hepatic multilobular hemorrhagic necrosis, associated with marked changes of liver arterioles and small hepatic veins. Since oral contraceptives have been incriminated in the genesis of hepatic vascular alterations, the possible relationship between focal hemorrhagic necrosis of the liver and these agents is suggested.

[Acute haemorrhagic pancreatitis. Criteria of letality (author's transl)]

A retrospective study of severity symptoms in a series of 102 patients operated upon for acute haemorrhagic pancreatitis showed that the risk of death was much significantly higher when shock (p less than 0,00001) and renal failure (p less than 0,0001) were present. The association, during the post-operative period, of shock and renal failure with one of the following symptoms: digestive haemorrhage, psychic disorders, pulmonary oedema, post-operative peritonitis and evisceration invariably proved fatal. It is suggested that controlled therapeutic trials should be carried out in patients presenting with these complications.