Liver Hematoma Research Articles

Morts maternelles par complications hypertensives. Résultats de l’enquête confidentielle française sur la mortalité maternelle, 2010–2012

Between 2010 and 2012, the rate of maternal death caused by hypertensive disorders (0,5/100,000 living birth) was reduced by 50% compared to the 2007–2009 period. Hypertensive disorders were responsible from 5% of maternal deaths and from 10% of direct maternal mortality. Eleven deaths happened during the postpartum period but 9 hypertensive complications began before delivery. Seventy percent of these deaths seem to be avoidable. The main causes of suboptimal management were: unappropriated or insufficient obstetrical and anesthetic treatments, undiagnosed HELLP syndrome and subcapsular liver hematoma, delayed treatment. The analysis of these maternal deaths gave the opportunity to stress some major lessons to optimize medical management in case of hypertensive diseases during pregnancy: abdominal symptoms during third trimester of pregnancy lead to search hypertensive disorders; HELLP syndrome with severe anemia indicate to carry out abdominal ultrasound.

Incidental Findings on Routine Targeted Neonatal Echocardiography Performed in Preterm Neonates Younger Than 29 Weeks' Gestation.

The aim of this study was to quantify the rate of incidental findings identified on elective research echocardiography performed on neonates younger than 29 weeks' gestation. We conducted a retrospective study of echocardiographic examinations performed within the first 24 hours of age on neonates younger than 29 weeks' gestation over a 3-year period for research purposes. Incidental echocardiographic findings and pertinent clinical data were recorded. Echocardiographic examinations performed on 145 neonates were retrospectively reviewed. Forty-three neonates (30%) had a total of 54 unexpected findings (37%). Most comprised malpositioned umbilical venous catheters, where the tip was located in the left atrium. The remainder of the conditions identified included unsuspected congenital heart disease, liver hematomas, and unexpected pulmonary hypertension. There is a high rate of incidental findings identified on screening echocardiograms. Routine targeted neonatal echocardiographic screening of preterm neonates may be warranted to identify the considerable likelihood of asymptomatic findings.

Endoscopic Ultrasound Liver Biopsies Accurately Predict the Presence of Fibrosis in Patients With Fatty liver

Endoscopic Ultrasound Liver Biopsies Accurately Predict the Presence of Fibrosis in Patients With Fatty liver

Diagnosis and Management of HELLP Syndrome Complicated by Liver Hematoma.

Subcapsular liver hematoma is a rare but potentially life-threatening complication of preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. It may present with nonspecific signs and symptoms, none of which are diagnostic, and can mimic pulmonary embolism of cholecystitis. There is no consensus on the management of subcapsular liver hematoma. Unruptured liver hematoma can be conservatively managed. When rupture occurs, surgical, endovascular approaches and, rarely, liver transplantation, may be required. Actual literature is scant and retrospective in nature. Data on follow-up, time to resolution and outcome of subsequent pregnancies are very limited. We here review the diagnosis and management of liver hematoma.

Intensive Care Unit issues in eclampsia and HELLP syndrome

Preeclampsia, eclampsia and HELLP syndrome are life-threatening hypertensive conditions and common causes of ICU admission among obstetric patients The diagnostic criteria of preeclampsia include: 1) systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg on two occasions at least 4 hours apart and 2) proteinuria ≥300 mg/day in a woman with a gestational age of >20 weeks with previously normal blood pressures. Eclampsia is defined as a convulsive episode or altered level of consciousness occurring in the setting of preeclampsia, provided that there is no other cause of seizures. HELLP syndrome is a life-threatening condition frequently associated with severe preeclampsia-eclampsia and is characterized by three hallmark features of hemolysis, elevated liver enzymes and low platelets. Early diagnosis and management of preeclampsia, eclampsia and HELLP syndrome are critical with involvement of a multidisciplinary team that includes Obstetrics, Maternal Fetal Medicine and Critical Care. Expectant management may be acceptable before 34 weeks with close fetal and maternal surveillance and administration of corticosteroid therapy, parenteral magnesium sulfate and antihypertensive management. Worsening condition requires delivery. Complications that can be related to this spectrum of disease include disseminated Intravascular coagulation (DIC), acute respiratory distress syndrome, stroke, acute renal failure, hepatic dysfunction with hepatic rupture or liver hematoma and infection/sepsis.

An Unusual Case of Severe Preeclampsia in the Postpartum Period with Hemoperitoneum

ABSTRACT Background HELLP syndrome, consisting of hemolysis, elevated liver enzymes, and low platelet count, is a rare complication of occurring in 10 to 20% of women with severe preeclampsia and in 0.2 to 0.6% of total pregnancies. Delivery is the only definitive treatment, with maternal condition usually improving in the postpartum period. Hemoperitoneum in a woman with preeclampsia is very rare, usually secondary to hepatic hematoma with rupture. While the prevalence of intrahepatic hematoma in these women has been reported to be as high as 39%, capsular rupture is rare, occurring up to 12% in women with capsular hematoma, carrying with it high mortality for both the mother and fetus. Aim We report an unusual case of hemoperitoneum secondary to liver hematoma in severe preeclampsia in the postpartum period that was conservatively managed leading to good maternal outcome. Case report We report a case of postpartum onset of severe preeclampsia in a 25-year-old woman complicated by hepatic dysfunction with coagulopathy and hemoperitoneum. This was secondary to a contained subcapsular hematoma and was conservatively managed resulting in a good outcome. Conclusion Prompt recognition with careful clinical examination, laboratory investigations and imaging, supportive treatment, and early fetal delivery remain the cornerstone in the management. Although reaching the diagnosis was initially challenging in our case study, both mother and baby had a good outcome with an appropriate supportive treatment. Clinical significance Most cases with liver hematomas may lead to hepatic rupture with hemodynamic instability, necessitating an aggressive operative approach. However, conservative management with close monitoring of hemodynamic status can be undertaken if the patient is hemodynamically stable with good outcome, as illustrated in this case. How to cite this article Loh M, Kathirvel R. An Unusual Case of Severe Preeclampsia in the Postpartum Period with Hemoperitoneum. J South Asian Feder Obst Gynae 2017;9(4):363-366.

Subcapsular left hepatic lobe hematoma: A potentially life-threatening post-ERCP complication

Endoscopic retrograde cholangiopancreatography (ERCP) is minimally invasive procedure commonly performed for biliary and pancreatic diseases. According to literature, the most common related complication are pancreatitis, post-sphincterotomy bleeding, perforation and cholangitis. This is rare and exceptional ERCP complication and only few cases have been reported. We report a case of rare post-ERCP complication, subcapsular liver hematoma that was diagnosed 16 hour post-ERCP in 28-year-old lady with intra-abdominal collection, ultrasound guided drainage of suspected bile leak was done, but the drained fluid was bloody (blood mixed with bile), with total amount of 900 ml in the first 36 hours. Patient received 2 units packed RBCs and she maintain her vital sign and hemoglobin 8.5 g/dl. Computed tomography scan of abdomen revealed a large left hepatic lobe subcapsular hematoma 16x7x12 cm with no active bleeding causing compression of the left hepatic vessels. On the basis of laboratory, clinical, and hemodynamic parameters the patient was hemodynamically stable. She was managed conservatively with only ultrasound guided drained of abdominal collection and no any radiological or surgical intervention needed for the hematoma.

A Fatal Case of Complicated HELLP Syndrome and Antepartum Eclamptic Fit with Ruptured Subcapsular Liver Hematoma

Abstract Objective To describe a fatal case of ruptured subcapsular liver hematoma as regards diagnoses and management. Design Case report. Setting Department of Obstetrics and Gynecology. Patient A 25-year-old woman developed HELLP syndrome and antepartum eclamptic fit complicated with ruptured subcapsular liver hematoma during the 28th week of pregnancy. Intervention Midline abdominal exploratory laparotomy, with delivery by caesarean section. Tight abdominal packing for the hematoma and Pringle maneuver were done. Partial couvelaire uterus was managed by prostaglandins and B-Lynch brace sutures to minimize uterine bleeding and atony. The patient developed postoperative hepatic, renal failure, coagulopathy, deterioration and finally death. Conclusion(s) Ruptured subcapsular liver hematoma is a life-threatening condition that should be considered in pregnant women with HELLP syndrome and severe preeclampsia presenting with symptoms and signs of hemorrhagic shock, hemoperitoneum and the liver should be evaluated with ultrasound before delivery. In these patients delivery of the fetus is the first step and the best approach is a midline abdominal incision. Also, regular antenatal care is very important through all trimesters.

Hematoma hepático asociada a eclampsia y síndrome de Hellp

Hematoma hepático asociada a eclampsia y síndrome de Hellp

A case of traumatic rupture of a giant omphalocele and liver injury associated with transverse lie and preterm labor

Abstract Perinatal omphalocele rupture is a rare occurrence. We present a case of a baby delivered at 35 weeks with a known giant omphalocele, transverse lie, and the omphalocele downward in the birth canal who suffered rupture of the omphalocele and liver injury around the time of delivery. The pregnancy was complicated by one day of preterm labor, preterm premature rupture of the membranes, and the omphalocele was the presenting part. Despite pulmonary hypertension, rupture of the omphalocele, and a significant liver injury, individualized management with decompression of the liver hematoma allowed successful early closure with mesh followed by delayed reconstruction.

Safety of reducing the recovery time after percutaneous and laparoscopic liver biopsy

Abstract Background Liver biopsy is the main diagnostic tool for the study of the liver, and as such, its inherent complications have been minimised as much as possible over the years, through the modification of several factors regarding its procedure, including post-biopsy recovery time. The aim of this study was to evaluate the safety in the reduction of post-liver biopsy recovery time. Material and methods A non-blinded, randomised clinical trial was conducted in the “Hermanos Ameijeiras” Hospital from November 2011 to October 2012, on 128 patients in order to assess safety when reducing post-biopsy recovery times. The patients were randomised into 2 groups. Group A was allowed a 6-h recovery time, while Group B was allowed a 2-h recovery time after liver biopsy. Complications were fully recorded. The Chi squared test of homogeneity and Student t test was used as appropriate, in the statistical analysis, a significance level of 0.05 was set. Results The main biopsy indication was elevated plasma transaminases. Pain in the puncture site was the most recurrent complication (67.2%), and the most serious complication was subcapsular liver haematoma in two cases (1.6%). There were no differences regarding the liver biopsy technique that could have caused complications in any group. Conclusions There were no significant differences between 2 h and 6 h post-liver biopsy recovery time in terms of complications, so it is considered that after 2 h the patient is incorporated more quickly into their activities, and the institution spends less material and human resources.

Scrotal Hematoma as a Sign of Subcapsular Liver Hematoma in a Preterm Infant

a Tepecik Training and Research Hospital, Department of Neonatology, Izmir, Turkey b Sitki Kocman University, Faculty of Medicine, Department of Neonatology, Mugla, Turkey c Tepecik Training and Research Hospital, Department of Radiology, Izmir, Turkey d Dr Behcet Uz Children’s Hospital, Department of Neonatology, Izmir, Turkey e Katip Celebi University, Faculty of Medicine, Department of Neonatology, Izmir, Turkey

Liver Hematoma Presented as Midgut Volvulus Due To Medical Error: A Case Report

Introduction: The use of an umbilical catheterization is a usual practice in neonatal units. The insertion of the catheter has potential complications. Case Presentation: Here, we report on our observation of a seven-day-old female newborn admitted for an abdominal distention and vomiting bile. Initially, diagnosis was midgut volvulus, for which an operation was performed. During the surgery, no intestinal malrotation, mesenteric defect or atresia was observed. Postoperative diagnosis was abdominal wall hematoma and rand ligament and ileus, as well as, sub-capsular liver hematoma. The patient had been hospitalized at birth at a neonatal intensive care unit (NICU). With the appearance of icterus on the first day of life, at the NICU tried to insert the umbilical catheter that had been filed. Conclusions: The complication found in the patient was the result of an aggressive act (the umbilical catheter insertion). This intervention should not be carried out unless there are clear indications, and if so, it should be done with much care.

Percutaneous Ablation of Hepatic Tumors Using Irreversible Electroporation: A Prospective Safety and Midterm Efficacy Study in 34 Patients

PurposeTo evaluate the safety and efficacy of percutaneous irreversible electroporation (IRE) of primary and secondary liver cancer unsuitable for resection or thermal ablation. Materials and MethodsIn this prospective, single-center study, 65 malignant liver tumors (hepatocellular carcinoma, n = 33; cholangiocellular carcinoma, n = 5; colorectal cancer metastasis, n = 22; neuroendocrine cancer metastasis, n = 3; testicular cancer metastasis, n = 2) in 34 patients (27 men, 7 women; mean age, 59.4 y ± 11.2) were treated. Local recurrence-free survival (LRFS) according to the Kaplan-Meier method was evaluated after a median follow-up of 13.9 months. ResultsMedian tumor diameter was 2.4 cm ± 1.4 (range, 0.2–7.1 cm). Of 65 tumors, 12 (18.5%) required retreatment because of incomplete ablation (n = 3) or early local recurrence (n = 9). LRFS at 3, 6, and 12 months was 87.4%, 79.8%, and 74.8%. The median time to progressive disease according to modified Response Evaluation Criteria In Solid Tumors was 15.6 months. Overall complication rate was 27.5% with six major complications and eight minor complications. Major complications included diffuse intraperitonal bleeding (n = 1), partial thrombosis of the portal vein (n = 1), and liver abscesses (n = 4). Minor complications were liver hematomas (n = 6) and clinically inapparent pneumothoraces (n = 2). ConclusionsIRE showed promising results regarding therapeutic efficacy for the percutaneous treatment of liver tumors; however, significant concerns remain regarding its safety.

Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent.

BackgroundThe transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications.ObjectivesTo describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success.Patients and MethodsTwenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded.ResultsThe portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P < 0.001). Procedure-related complications included acute tract occlusion (n = 2), liver hematoma (n = 1), hepatic encephalopathy (n = 1), and cardiac failure (n = 1). Three of the 26 patients had late-onset TIPSS occlusion (at 12, 12, and 39 months after TIPSS creation). Three patients died within one week after the procedure due to their poor general condition (multiorgan failure, acute respiratory distress syndrome, necrotizing pancreatitis, and aspiration pneumonia). Another four patients succumbed to their underlying advanced liver disease within one year after TIPSS insertion. Seven patients underwent OLT at a mean time of 9.4 months after TIPSS creation.ConclusionThe sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS procedure per se rather than to the particular stent system employed in this study.

Term Neonate With Liver Laceration, Obstructive Uropathy, and Ascites-Secondary to Extravasation of Total Parenteral Nutrition: A Complication of Malpositioned Umbilical Venous Catheter.

We report a rare, but serious, complication of a malpositioned umbilical venous catheter in a term male infant who developed laceration, hematoma, and necrosis of liver, ascites, and left-sided obstructive uropathy secondary to extravasation of total parenteral nutrition. Abdominal paracentesis confirmed the presence of parenteral nutrition in the peritoneal cavity. Although, the umbilical venous catheterization is a common intravenous access used in neonatal intensive care units, judicious continued monitoring of its use should be practiced to avoid serious complications.

Subcapsular liver hematoma due to endoscopic retrograde cholangiopancreatography: case report

Subcapsular hematoma due to endoscopic retrograde cholangiopancreatography is a rare complication. There are only a few case reports in this subject in literature. This report’s aim is to present subcapsular hematoma due to endoscopic retrograde cholangiopancreatography case and compare it with the literature. A sixty-nine-year-old female patient was admitted to the clinic with abdominal pain and jaundice. In physical examination epigastric tenderness was present. Patient went under ERCP procedure due to choledocholithiasis. 1.5 cm of filling defect was seen in hilar region in ERCP. The gallstone was extracted with endoscopic sphincterotomy, balloon and basket. 12 hours after being discharged, patient admitted to the emergency service presenting low blood pressure, fatigue and abdominal pain. Arterial blood pressure and heart rate was respectively 90/60 mmHg and 100 bpm. Abdominal examination presented tenderness, guarding and rebound in all quadrants. Ultrasonography and general abdominal computed tomography showed subcapsular liver hematoma and subdiaphragmatic free air. The patient was operated due to acute abdomen. During exploration, laceration and subcapsular hematoma was present on the anterior face of the right lobe. Lacerated area was sutured simply. Postoperative day 9 patient was discharged with no complications. Patient was admitted presenting fever and abdominal pain postoperative month 1. USG and CT revealed that an approximately 10x3 cm heterogenic collection adjacent to the left lobe of the liver was reaching out to epigastrium. Percutaneous drainage was performed. Drainage was continued for 1 week. Control USG revealed regression and drainage was terminated. No complications were observed in patients 1 year of follow-up. Subcapsular hematoma of the liver is a rare complication. It should be considered in case of sudden hypotension and abdominal pain after ERCP. Conservative treatment should be considered in the foreground, however, surgery should be scheduled in case of acute abdomen and/or hemodynamic instability.

Unexpected Massive Hemothorax After Pancreatic Islet Transplantation: A Case Report

The percutaneous transhepatic portal approach is the most commonly used technique for islet transplantation, largely owing to its safety and minimally invasive characteristic. Bleeding complications after islet transplantation are rare and include portal vein thrombosis and subcapsular liver hematoma. We report a massive hemothorax after portal vein catheterization in a patient with brittle type 1 diabetes undergoing hepatic islet embolization. The patient was under long-term aspirin therapy because of vascular complications and received heparin in low doses to prevent the instant blood-mediated inflammatory reaction and reduce the risk of portal vein thrombosis. The present case illustrates the particular risk of bleeding complications in patients with brittle type 1 diabetes, who represent a frail population. This uncommon adverse event highlights the importance of close monitoring in the first days following islet transplantation.

Sonographic Diagnosis of Subcapsular Liver Hematoma in Newborn: A Case Report

We report clinical details and imaging findings of a case of subcapsular liver hematoma (SLH) occurring as incidental finding in a newborn with scrotal hematoma. We present this case to alert that SHL should be added to the list of differential diagnoses of neonatal liver lesions, despite the lack of associated risk factors.

Seguridad de la reducción del tiempo de reposo posbiopsia hepática percutánea y por vía laparoscópica

BackgroundLiver biopsy is the main diagnostic tool for the study of the liver, and as such, its inherent complications have been minimised as much as possible over the years, through the modification of several factors regarding its procedure, including post-biopsy recovery time.The aim of this study was to evaluate the safety in the reduction of post-liver biopsy recovery time. Material and methodsA non-blinded, randomised clinical trial was conducted in the “Hermanos Ameijeiras” Hospital from November 2011 to October 2012, on 128 patients in order to assess safety when reducing post-biopsy recovery times. The patients were randomised into 2 groups. Group A was allowed a 6-hour recovery time, while Group B was allowed a 2-hour recovery time after liver biopsy. Complications were fully recorded. The Chi squared test of homogeneity and Student t test was used as appropriate, in the statistical analysis, a significance level of 0.05 was set. ResultsThe main biopsy indication was elevated plasma transaminases. Pain in the puncture site was the most recurrent complication (67.2%), and the most serious complication was subcapsular liver haematoma in two cases (1.6%). There were no differences regarding the liver biopsy technique that could have caused complications in any group. ConclusionsThere were no significant differences between 2 hours and 6 hours post-liver biopsy recovery time in terms of complications, so it is considered that after two hours the patient is incorporated more quickly into their activities, and the institution spends less material and human resources.