Etiology and management of hemmorrhage in spontaneous liver rupture: a report of 70 cases

Chen, Zhe-Yu; Qi, Qing-Hui; Zhao, Dong

doi:10.3748/wjg.v8.i6.1063

Cited by 77 publications

(51 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[7] In a series of 70 cases of spontaneous liver hemorrhage reported by Chen et al, the cause was HCC rupture in 60 patients, cirrhosis without underlying tumor existence in three, hemangioma in two, hepatocellular adenoma in four and a bleeding metastatic lesion in only one patient. [8] These hypervascular tumors can usually be revealed after accidents which involve liver trauma and thus about 10% of HCC would present in such a way, responsible for the deaths of 3% of patients with HCC in a large Swedish series. [9] Massive hemorrhage related to ruptured liver metastases is quite exceptional and less than 50 cases are reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature

Maroulis¹,

Spyropoulos²,

Kalogeropoulou³

et al. 2013

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

Active liver hemorrhage with hemodynamic instability is a serious situation often requiring surgical intervention. The most common causes of hepatic bleeding are trauma and tumors of the liver parenchyma: mainly hepatocellular carcinoma and adenoma. Liver hemorrhage from blunt trauma or spontaneous tumor rupture is sometimes difficult to control with traditional methods and postoperative complications are frequent. Recently, the radiofrequency ablation system (RF) has been used for obtaining haemostasis of ruptured hepatic tumors or for controlling hemorrhage due to liver trauma in experimental models. We report two cases where the radiofrequency ablation system (RF) has been efficiently used during emergency laparotomy in humans in order to control massive hemorrhage from spontaneous rupture of a liver metastatic testicular germ cell tumor and from a Grade IV blunt liver trauma. RF ablation system combined with traditional techniques was effective in controlling liver bleeding during laparotomy in both cases. No recurrence of the hemorrhage or any side effects associated with the RF system were recorded postoperatively. RF system is an effective strategy for achieving hemostasis in patients with active liver hemorrhage. In cases of bleeding liver tumors, RFA could also be helpful in synchronous tumor elimination, maximizing the chances of longer term survival.Key Words: Hemorrhage; liver; radio frequency ablation.Hemodinamik instabiliteyle birlikte aktif karaciğer kanaması sıklıkla cerrahi girişimi gerektiren ciddi bir durumdur. Karaciğer kanamasının en sık görülen nedenleri travma, başlıca hepatoselüler karsinom ve adenom olmak üzere karaciğer parankimi tümörleridir. Künt travma veya spontane tümör rüptürünü bazen klasik yöntemlerle kontrol altına almak zorlaşmakta ve sık sık ameliyat sonrası komplikasyonlar görülmektedir. Son zamanlarda rüptüre karaciğer tü-mörlerinde hemostazı sağlamak veya deneysel modellerde karaciğer travmasına bağlı kanamayı kontrol altına almak için radyofrekans ablasyon (RFA) sistemi kullanılmakta-dır. İnsanlarda karaciğerde metastatik testis germ hücreli tümörün spontane rüptürüne ve grade IV künt karaciğer travmasına bağlı masif kanamanın kontrol altına alınma-sı için acil laparatomi sırasında RFA sisteminin etkinlikle kullanılmış olduğu iki olgu sunuyoruz. Klasik tekniklerle kombine edilmiş RFA sistemi her iki olguda da laparotomi sırasında karaciğer kanamasını kontrol altına almada etkili olmuştur. Ameliyat sonrası dönemde RFA sistemiyle ilişki-li herhangi bir kanama nüksü veya yan etki kaydedilmedi. Aktif karaciğer kanaması olan hastalarda hemostazı sağla-ma açısından RFA sistemi etkili bir stratejidir. Kanayan karaciğer tümörlerinde RFA aynı zamanda eş zamanlı olarak tümörün ortadan kaldırılmasına yardımcı olarak daha uzun sağkalım şansını en üst düzeye çıkartabilir.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature

Maroulis¹,

Spyropoulos²,

Kalogeropoulou³

et al. 2013

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…Modalitiesused to diagnose it are Ultrasonography (US) 46% sensitivity [3], Dynamic contrast-enhanced computed tomography (CT) 66% sensitivity [14,15], Nuclear medicine studies using technetium (Tc) 99m-labeled RBCs [16,17], Magnetic resonance imaging (MRI) 96% sensitivity [17,18], Hepatic arteriography, and Digital subtraction angiography (DSA). Liver biopsy can help provide an unequivocal histologic diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Haemangioma are composed of masses of blood vessels that are atypical or irregular in arrangement and size. Exact aetiology remains unknown [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Rupture of Liver Haemangioma-A Case Report & Review of Literature

Islam¹,

Naraynsingh²

2014

Surgery

View full text Add to dashboard Cite

A 31yrs old female patient presented with three day history of sudden right upper quadrant pain which progressively worsened over the last 24 hours. She is a known asthmatic controlled by Nasacort inhaler and also a known case of polycystic ovary diseases using oral contraceptive pills over the last 9 years.On physical examination revealed a young female in mild painful distress. Her mucous membrane was pink and moist. She was warm to touch with a temperature of 38.4°C and her vitals were within normal limit. Abdominal examination revealed moderate tenderness in right upper quadrant with mild guarding but no rebound tenderness.An USS of abdomen revealed a normal gall bladder with no peri-cholecystic fluids or gall stones with a normal CBD. However, a 7.77 x 9.42 cm cystic mass was noted in right lobe of liver and there was no free fluid ( Figure 1). A CXR revealed right basal consolidation. Her WBC was elevated 26.2 and she was also anaemic with an Hb of 11 mg/dl. Her renal function as well as electrolytes were within normal limit, however her liver enzymes were elevated AST-600, ALT-1900, ALP-238, GGT-166 with normal serum bilirubin and amylase level.After 24 hours her pain became severe and she became tachycardic with a pulse of 130 bpm with persistently elevated temperature (38.0°C). Her blood pressure and Spo2 was normal. There was decreased air entry at right lung base. Abdominal examination revealed marked tenderness with guarding but no rebound tenderness and there was sluggish bowel sound. Patient Hb had dropped from 10 gm/dl to 8 gm/dl. An Urgent CT scan of abdomen and pelvis with intravenous contrast revealed that the cyst (haemangioma) has ruptured with free fluid (blood) in Morrison pouch and in right Para-colic gutter (Figure 2). Subsequently patient developed moderate respiratory distress and was reviewed by medicine specialist. A Spiral CT of the chest-revealed mild right pleural effusion with fluid in oblique fissure but no evidence of pulmonary embolism. An MRI of abdomen was also performed which reconfirm the ruptured hepatic haemangioma. Patient was admitted in HDU and was managed successfully and discharged home on day-12.Patient had a high ESR of 39 and her liver function test became normal. Her serum alpha fetoprotein, CEA, Ca 19-9, anti-nuclear DNA levels were within normal limit. DiscussionHemangioma is the most common benign tumour affecting the liver [1,2]. Hepatic haemangioma are mesenchymal in origin and usually are solitary. Haemangioma are composed of masses of blood vessels that are atypical or irregular in arrangement and size. Exact aetiology remains unknown [3][4][5].Several pharmacologic agents have been postulated to promote tumour growth. Steroid therapy [6], oestrogen therapy, and pregnancy [7,8] can increase the size of an already existing hemangioma. Our patient was on inhalational steroid therapy for her asthmatic condition and was also on oral contraceptive pills for her polycystic ovarian disease.Incidence rate 2% in USA & the prevalence rate at necropsy is 7.4%, usual...

show abstract

“…They are often diagnosed as incidental findings on imaging studies of the abdomen during exploratory surgeries [2] . It is estimated that about 20% of the general population present hepatic hemangiomas, and the prevalence in autopsy studies ranges between 0.4%-7.4% [3][4][5] . These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life [1,6,7] .…”

Section: Introductionmentioning

confidence: 99%

Spontaneous rupture of hepatic hemangiomas: A review of the literature

Ribeiro

Papaiordanou²,

Gonçalves³

et al. 2010

WJH

View full text Add to dashboard Cite

Hepatic hemangiomas are congenital vascular malfor mations, considered the most common benign me senchymal hepatic tumors, composed of masses of blood vessels that are atypical or irregular in arran gement and size. Hepatic hemangiomas can be divided into two major groups: capillary hemangiomas and cavernous hemangiomas These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life. Most cases are asymptomatic although a few patients may present with a wide variety of cli nical symptoms, with spontaneous or traumatic rup ture being the most severe complication. In cases of spontaneous rupture, clinical manifestations consist of sudden abdominal pain, and anemia secondary to a haemoperitoneum. Disseminated intravascular coagulo pathy can also occur. Haemodynamic instability and signs of hypovolemic shock appear in about one third of cases. As the size of the hemangioma increases, so does the chance of rupture. Imaging studies used in the diagnosis of hepatic hemangiomas include ultra sonography, dynamic contrastenchanced computed tomography scanning, magnetic resonance imaging, hepatic arteriography, digital subtraction angiography, and nuclear medicine studies. In most cases hepatic hemangiomas are asymptomatic and should be followed up by means of periodic radiological examination. Sur gery should be restricted to specific situations. Ab solute indications for surgery are spontaneous or trau matic rupture with hemoperitoneum, intratumoral blee ding and consumptive coagulopathy (KassabachMerrit syndrome). In a patient presenting with acute abdo minal pain due to unknown abdominal disease, sponta neous rupture of a hepatic tumor such as a hemangio ma should be considered as a rare differential diagno sis.

show abstract

Etiology and management of hemmorrhage in spontaneous liver rupture: a report of 70 cases

Abstract: The results suggest that surgical intervention is still the main therapeutic method and the best procedure that should be selected according to causes of disease and patient's condition and history.

Cited by 77 publications

References 23 publications

Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature

Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature

Spontaneous Rupture of Liver Haemangioma-A Case Report & Review of Literature

Spontaneous rupture of hepatic hemangiomas: A review of the literature

Contact Info

Product

Resources

About