Pielosis Hepatis: A Rare Entity Associated with Hemoperitoneum and Mayor Hepatectomy in Emergency

Abstract

A 24-year-old man, with no medical history, presented with intense pain in the right upper quadrant of the abdomen, associated with tachycardia. Associated imaging examinations reveal a hepatic tumor mass in the right lobe, segments V, VI, VII, VIII. by ultrasound. The tomography study reveals the right liver mass associated with increased hemoperitoneum. hemoglobin at 7 gr /dl, received blood products. Immediately he was admitted to the operating room and an exploratory laparotomy, intraoperative ultrasound, and Right Hepatectomy were performed. Subsequent management in the ICU intensive care unit, progressed favorably. He was discharged on the seventh day. Subsequent pathological study showed a diagnosis of Peliosis hepatis characterized by multiple, small, blood-filled cysts within the Liver parenchyma. One year follow-up is with nuclear magnetic resonance with contrast and no other alteration is evidenced. Pielosis Hepatis is an entity extremely rare that comes to the surgeon’s attention just after the rupture, even spontaneous, of the lesion, resulting in a massive hemoperitoneum. In this particular case, Pielosis Hepatis becomes a potentially fatal disease and we have less than 50 cases with its presentation associated with hemoperitoneum in the world literature. In the case of Hepatic Pyelosis, its generally asymptomatic until it can begin with massive bleeding that can be fatal, where it should be suspected in differential diagnoses in order to have a diagnostic and therapeutic approach. A multidisciplinary team must be equipped to be able to treat these cases in a timely and successful manner, such as the one presented.