Intrahepatic Rupture Research Articles

S3041 Hepatic Artery Dissection – A Case Report

Introduction: Visceral artery aneurysms are rare pathologies with reported incidence rates between 0.01% to 0.2%; even rarer are hepatic artery dissections (HAD). Most aneurysms rupture or are incidentally found on autopsy, but imaging advancements has enabled earlier identification of aneurysms; in this case, a HAD. Case Description/Methods: A 77-year-old female with medical history pertinent for sickle cell trait, acquired factor VIII inhibitor coagulopathy, history of type 2 thoracic aortic dissection, and hypertension presented to the emergency room with a week of mild fatigue, postprandial epigastric burning pain, and intermittent stabbing right upper quadrant pain. Right upper quadrant ultrasound demonstrated a hypervascularized right hepatic lobe mass with large tortuous internal vessels. CT abdomen & pelvis without contrast showed a large hypodensity in the right liver with curvilinear density. MRI demonstrated large arteriovenous malformation (AVM) within the right hepatic lobe and focal hepatic parenchymal hemorrhage centered within AVM nidus. Gastroenterology was consulted and CT angiogram findings were suspicious for common HAD, proper hepatic & intrahepatic pseudoaneurysms, and intrahepatic rupture. Interventional radiology was consulted. Hepatic angiogram showed a large defect in the proximal hepatic artery with brisk opacification, thought to represent a pseudoaneurysm. This prompted framing coil placement across the large defect and coils extending from the proper hepatic artery to the common hepatic artery with significant reduction in forward flow & pseudoaneurysm opacification. Per hepatobiliary & vascular surgery, no need for additional surgical intervention. Postoperative course was complicated by fever & leukocytosis, worsening kidney injury, and anemia; attributed to the procedure and resolved with supportive care. Patient discharged on postoperative day 8 with outpatient follow-up. (Figure) Discussion: This case highlights the importance of imaging for earlier detection of hepatic artery aneurysms (HAA) in minimizing risk of catastrophic hemorrhage. HAA are rare but clinically important given they are associated with high incidence of rupture and mortality up to 20%. Although surgery is preferred for extrahepatic findings, endovascular interventions are favored for intrahepatic findings depending on size and presence of pseudoaneurysms, such as this case. They have led to more favorable short & longer-term outcomes and lower mortality & morbidity rates, particularly in poor surgical candidates.Figure 1.: Hepatic angiography and embolization was performed. A large defect with brisk opacification of the proper and common hepatic arteries were seen (A), prompting deploy of a framing coil. (B) Embolization was then performed on the hepatic artery with three coils (5mm, 6mm, & 8mm). Coils were examined from proper hepatic artery to the common hepatic artery. (C) Following placement of the coils, significant reduction in flow and opacification of the pseudoaneurysm was seen.

A case of gallbladder perforation accompanied by intrahepatic rupture observed by abdominal ultrasonography

A case of gallbladder perforation accompanied by intrahepatic rupture observed by abdominal ultrasonography

Malignant intraductal papillary neoplasm of the bile duct with intrahepatic rupture

Mucin producing intraductal papillary neoplasm of the bile duct(IPMN-B) has previously been reported in various terms including intraductal papillary neoplasia of the liver, mucin-hypersecreting biliary papillomatosis, and mucin-producing cholagiocarcinoma. Malignant IPMN-B is a referred as intraductal growth type of intrahepatic chlangiocarcinoma (ICC), which is a rare disease and reveal a more favorable prognosis. Therefore we reported malignant intraductal papillary neoplasm of the bile duct with intrahepatic rupture. Case report: A 52-year male was admitted for RUQ pain and fever. Vital sign was stable and he showed mild tenderness of RUQ abdomen. Initial laboratory test revealed WBC 14700, Hg 11.7, Plt 132000, and AST/ALT of 1880/1770IU/L, T B 2.23mg/dL, AFP of 1.47ng/mL, ca19-9 of 16.2 U/mL, and Initial ABDO CT was shown subcapsular hemobilia in right liver with internal enhancing mass in left bile duct, so diagnosed malignant IPMN-B with intrahepatic rupture. Pet-CT was shown no distant metastasis and the high FDG uptake in the tumor with in left bile duct. The S4 bile duct with mass was attached to middle hepatic vein, so we performed a modified left hepatectomy with segmental resection of middle-hepatic vein and reconstruction with gore-tex. Operation time was 7hr 30 min and blood loss was 350cc. It diagnosed well differentiated, 6x4x2.5cm sized, intraductal papillary carcinoma of the bile duct. There was no metastasis of regional lymph node. The patient had no postoperative complications and was discharged. Conclusion: Through precise preoperative diagnosis and wide complete resection of malignant IMN-B, a more favorable prognosis can be expected.

Multifocal Intrahepatic Artery Aneurysm with FDG-avid Thrombosis Simulating Metastasis: Report of a Rare Case

Hepatic artery aneurysm (HAA), although rare, represents a serious diagnostic and therapeutic challenge due to high rupture rate and associated mortality. Early detection and accurate diagnosis are essential for successful management. Here, we present an extremely rare case of multi-focal intrahepatic HAA with confined intrahepatic rupture and hypermetabolic activity at PET imaging, simulating metastasis of melanoma. A retrospective review found only two other HAA at our institution between 2000 and 2015, both of which involved the extrahepatic artery. This report highlights the importance of clinical, radiological, and pathological correlation in the management of this rare condition.

Intrahepatic Rupture Of Gall Bladder In A Case Of Chronic Cholecystitis.

We present, a 69 years old gentleman, known case of cholelithiasis, who presented in septic shock, with history of severe right upper quadrant abdominal pain since 3 days. CT scan of his abdomen showed intrahepatic rupture of gall bladder with peripherally enhancing lesion in liver communicating with the gall bladder lumen suggestive of empyema gall bladder. Few gall stones appeared to have migrated into the liver parenchyma. He underwent ultrasound guided percutaneous cholecystotomy with a plan for elective cholecystectomy at a later date.

Intrahepatic rupture of empyema gallbladder

A 70-year-old woman presented with right upper quadrant pain and fever since 1 month, with exacerbation of symptoms since 1 week. Clinically, she had tenderness in the right hypochondrium; laboratory parameters showed elevated AST, ALT and alkaline phosphatase values. Ultrasonogram abdomen showed a large abscess in liver with suspicious communication with gallbladder. CT scan of abdomen showed a large irregular thick-walled cystic lesion in segments 5 and 8 of liver suggestive of a liver abscess. This cavity communicated with a thick-walled edematous gallbladder, that contained few calculi (Fig. 1). A diagnosis of empyema gallbladder with intrahepatic rupture and abscess formation in the liver was made. Ultrasound-guided percutaneous drainage of the abscess was done with a plan for elective laparoscopic cholecystectomy. Perforation of the gallbladder is a rare complication that occurs in 2 % to 11 % of acute cholecystitis; delay in diagnoses is a major cause of morbidity and mortality [1]. Niemeier classified gallbladder perforations into 3 types: type I—acute, manifests with generalized peritonitis; type II—subacute, which denotes localization of fluid at the site of perforation with formation of a pericholecystic abscess; and type III—chronic, in which internal or external fistula occur [2]. Our patient had Type II perforation. CT scan is more sensitive than ultrasonogram for the diagnosis of perforation [2], Visualization of the perforation “hole sign”, the demonstration of communication between the abscess and the gallbladder and points towards the diagnosis [3]. References

Intrahepatic rupture of a caudate lobe adenoma in liver adenomatosis

Hepatic adenomatosis is a rare benign disease that is more common in young and middle-aged women who are non-steroid dependent; it is usually symptomatic, progressive, and susceptible to hemorrhagic complications. Malignant transformation within adenomas is rare. The management of hepatic adenomatosis remains difficult due to the absence of predictive signs of complications, other than the size of the adenomas. Resective surgery is usually indicated, but liver transplantation could be an indication in highly symptomatic or progressive forms of the disease and represents the treatment of choice in cases of malignant transformation. We report a case of intrahepatic rupture of a caudate lobe adenoma which occurred in an adolescent with hepatic adenomatosis; we also present a brief review of the literature.

Intrahepatic huge hematoma due to rupture of small hepatocellular adenoma: a case report

Hepatocellular adenoma sometimes causes intraperitoneal hemorrhage. It is, however, rare for small hepatocellular adenoma to cause intrahepatic huge hemorrhage without intraperitoneal bleeding. Here we describe such a rare case of hepatocellular adenoma with huge intrahepatic hemorrhage in a 25-year-old female, who had taken oral contraceptives for the last 2 weeks. She was admitted to our hospital with a sudden onset of right-upper-quadrant abdominal pain and temporally fell in shock state. Plain CT depicted low density area measuring more than 13 cm in diameter in the right lobe of the liver. Huge tumor was also suggested by abdominal ultrasound, contrast enhanced CT, magnetic resonance imaging (MRI) and angiography. The patient was diagnosed as intrahepatic rupture of hepatic tumor. Because of the risk of re-hemorrhage and malignancy, she underwent right hepatic lobectomy. Histopathologial examination of the resected specimen showed a typical small hepatocellular adenoma with the surrounding huge hematoma in the liver. The case presented here is very rare but seems to be suggestive to the natural course and management of hepatocellular adenoma.

Skeletal Muscle Echinococcosis: A Rare Manifestation of Echinococcal Disease.

Skeletal Muscle Echinococcosis: A Rare Manifestation of Echinococcal Disease.

Non-traumatic intrahepatic rupture of the biliary tree with biloma: the place of ERCP

Non-traumatic intrahepatic rupture of the biliary tree with biloma: the place of ERCP

Intrahepatic Rupture Secondary to Duct Exploration Demonstrated by Cholangiography

Seven cases of iatrogenic rupture of the intrahepatic bile ducts were demonstrated on T-tube and/or operative cholangiography. This brings the total of documented case reports to 17. All patients had hepatic duct exploration with either the Fogarty balloon catheter and/or the biliary spoon and/or the biliary forceps and/or Bakes dilators. These extravasations usually occur from the right hepatic duct. The recognition of this entity is important because potentially serious complications may occur. Most of the previous cases of intrahepatic extravasation ascribed to excessive pressures of injection were probably surgically induced.