Intra-Abdominal Haemorrhage due to Traumatic Rupture of a Hepatic Cyst and Parenchymal Cystic Wall Laceration Following Blunt Abdominal Injury

Abstract

Intra-abdominal haemorrhage due to traumatic rupture of a hepatic cyst is sometimes fatal. Rupture of a hepatic cyst without bleeding does not necessarily need any surgical intervention or vice versa. However, a ruptured hepatic cyst accompanied by parenchymal hepatic laceration potentially leads patients to a lethal status, because of delayed intra abdominal haemorrhage. Furthermore, the patient was under warfarin therapy and even small lacerations may lead to significant bleeding and subsequent laparotomies. Therefore, close observation is important for patients whose hepatic cyst is ruptured, albeit without any signs of simultaneous haemorrhage on arrival. This is the case of an 87-year-old woman who had a road traffic accident and whose hepatic cyst was ruptured without simultaneous haemorrhage. The following morning, she demonstrated haemorrhagic shock. A subsequent CT scan revealed intra abdominal haemorrhage, and bleeding from the biggest hepatic cyst. Immediately, she underwent emergency surgery under the pringle manoeuvre, inferior vena cava (IVC) total clamping, and venovenous bypass (VVB) from the femoral vein to the internal jugular vein. The patient soon became systemically well. Generally, occlusion of hepatic inflow and infra hepatic IVC are crucial for control of hepatic and behind hepatic IVC bleeding. Furthermore, in order to avoid instability due to IVC total clamping, it is important to execute VVB especially for pulmonary hypertension or cardiomyopathy patients. J Med Cases. 2013;4(9):633-635 doi: http://dx.doi.org/10.4021/jmc1429w