Liver hematoma and rupture in pregnancy

Spontaneous idiopathic liver hemorrhage: a systematic review of a rare entity

BACKGROUND

Spontaneous idiopathic liver hemorrhage (SILH) is a rare life-threatening condition occurring without a clear and specific etiology. A systematic review was performed to provide guidelines for the perioperative management of patients affected by SILH. A case report was also included.

METHODS

A systematic search of the last 24-year literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines.

RESULTS

After an initial selection of 6995 titles, 15 articles were considered for the final qualitative analysis (n = 22 patients, including the present report). Conservative treatment was chosen in 12 cases (54.5%) with stable clinical conditions, while 9 patients (40.9%) required a primary operative approach for emergency presentation at diagnosis. Direct liver resection was the preferred surgical treatment (n = 6), mostly major hepatectomies (n = 4). Hepatic arterial embolization was performed as the primary operative approach in three patients, followed by emergency laparotomy during the same hospitalization because of rebleeding in one case. Contrast-enhanced CT scan was the gold standard for diagnosis (n = 19).

CONCLUSIONS

Conservative treatment of SILH is mainly based on stable clinical conditions and may be considered even in case of a limited arterial blush found on imaging. The absence of underlying hepatic or systemic disorders seems to correlate with favorable outcomes and no mortality.

Spontaneous rupture of the liver in a patient with chronic hepatitis B and D

Spontaneous rupture of the liver is a rare condition with serious consequences, if not recognized and treated in time. It has been reported as a complication of several disorders, including benign or malignant liver tumors, connective tissue disease, infiltrating liver disease, preeclampsia, and post anticoagulant therapy. We report a case of spontaneous rupture of liver in a non-cirrhotic, chronic hepatitis B and D patient presenting with acute hemoperitoneum and shock. The subcapsular hematoma and rupture of liver were documented by image studies. The patients' condition gradually stabilized after fluid resuscitation. The reported case and literature review suggest that spontaneous rupture of liver must be considered in a differential diagnosis of acute hemoperitoneum. A high index of suspicion and early diagnosis with imaging are critically important.

Survival following amniotic fluid embolism and cardiac arrest complicated by sub-capsular liver haematoma

We describe the anaesthetic and intensive care management of a 38-year-old mother with presumed amniotic fluid embolism who suffered cardiorespiratory collapse following delivery of a normal baby by caesarean section. After initial resuscitation, her recovery was complicated by development of disseminated intravascular coagulation and a large sub-capsular hepatic haematoma. We describe the initial resuscitative efforts and subsequent intensive therapy to full neurological recovery and discharge from hospital.

Liver disease in pregnancy

Liver dysfunction during pregnancy can be caused by conditions that are specific to pregnancy or by liver diseases that are not related to pregnancy itself. This review attempts to summarize the epidemiology, pathophysiology, and management of the different pregnancy-related liver diseases, and to review different liver diseases not related to pregnancy and how they may affect or be effected by pregnancy. Some of the liver diseases specific to pregnancy can cause significant morbidity and mortality both to the mother and to the fetus, while most of the liver diseases not specific to pregnancy do not have a deleterious effect on the pregnancy itself.

Traumatic liver rupture in pregnancy

Two pregnant women, 1 in the second trimester and 1 in the third trimester, sustained blunt liver trauma as unrestrained drivers in motor vehicle accidents. One patient had an overt injury that was apparent on computerized tomography and underwent surgical exploration when nonreassuring fetal monitoring occurred. The second patient, discharged after 23 hours of normal observation, returned a day later with overt intra-abdominal hemorrhage from an obvious liver laceration.