Liver Laceration A Very Rare Form Of Birth Trauma: A Case Report

Abstract

A case of haemoperitoneum in a neonate secondary to liver laceration following birth trauma is presented. The neonate was in a state of shock. The patient required an exploratory laparotomy & did very well postoperatively. It is a very rare form of birth trauma following assisted vaginal breech delivery. CASE A 36 weeks gestation baby was delivered at a district health facility by assisted breech delivery with grade 2 meconium & APGAR score 3, 4 & 7 . After initial resuscitation & subsequent nasotracheal intubation baby was referred to neonatal unit at our hospital. On examination the baby was 2.28 kg wt , pink in colour, no obvious congenital anomalies, swollen & decreased movement of left upper limb, right cephal haematoma, mild oozing from mouth from torn frenulum & considerable bruising noticed around the body. Radiological examination revealed fracture left clavicle. Patients Hgb was-14.gm/dl,WBC-40.3 x10 / , PLT115 x10 / μl Fourteen hours after admission to baby developed sudden pallor, was noted to be very lethargic with mild to moderate abdominal distension. Intra abdominal bleeding was suspected, baby was then electively ventilated by endotracheal tube, an urgent USS was done & referred to Paediatric Surgery. Hgb was then 5.7gm /dl, PLT-71 x10 / , WBC-24.5 x10 / μl USS of abdomen revealed 2.7cm x 2.3cm x2.3cm heterogeneous lesion noted in the posterior segments of right lobe of liver with free fluid in pelvis & around the liver. Diagnostic peritoneal aspiration revealed haemoperitoneum. Informed consent was obtained from parents & an emergency exploratory laparotomy was performed-due to sudden & severe decompensation –findings were :50ml blood around the liver, with a 2.5cm x 2cm sub-capsular hematoma on the inferior surface of right lobe of liver, the rest of abdominal findings were normal. The liver was packed with gel foam.