Massive spontaneous liver haemorrhage and acute liver failure due to Peliosis Hepatis in an inmunocompetent patient

Abstract

Background: Peliosis hepatis is a rare condition of unknown aetiology. It most commonly involves the liver and is characterised by cystic blood filled cavities throughout the parenchyma. Presentation varies from asymptomatic lesions to cholestasis, liver failure or spontaneous rupture. Diagnosis is often delayed as radiological appearances are suggestive of neoplasm, haemangioma or abscess. Methods: A 42-year-old woman presented with a one-day history of abdominal pain and distension. She was hypotensive and tachycardic. Results: On admission laboratory findings revealed haemoglobin of 6.4g/dL, platelets of 150x109, INR of 1.4 and deranged LFTs. CT showed near complete destruction of the right lobe of the liver with arterioportal shunting and active extravasation of contrast. She underwent embolisation of the right hepatic artery and wash out for haemoperitoneum. Post-operatively she developed acute hepatic failure and a right hepatic lobe abscess, which required percutaneous draining. She was discharged with drain in situ when laboratory results had normalised. MRI twenty months post embolization showed complete atrophy of the lesion with compensatory left hypertrophy. Conclusion: Peliosis hepatis should be considered as a differential diagnosis in acutely presenting liver masses, with associated intraperitoneal haemorrhage. It is often asymptomatic but may result in fatal haemorrhage and liver failure. Surgery should be reserved for cases where haemorrhage becomes life threatening.