Liver Rupture Research Articles

Spontaneous liver rupture associated with HELLP syndrome

Background: Spontaneous hepatic rupture is a rare life-threatening event seen among patients with preeclampsia and HELLP syndrome bringing devastating outcomes to both the mother and the baby.Case presentation: We report a case of a 45-year-old sub fertile primigravida following an IVF treatment with donor embryo resulting in DCDA twin pregnancy.She was diagnosed with pregnancy induced hypertension at 20 weeks of period of gestation (POG) with DCDA twin pregnancy admitted at our hospital at 32 + 4 weeks of POG with headache, visual disturbances, vomiting and abdominal pain with severe pregnancy induced hypertension. Category I emergency cesarean section was performed due to eclampsia, suspected placental abruption with DCDA twins with single fetal demise and acute kidney injury. During caesarean section, right lobe of the liver rupture was diagnosed. Even with intense multidisciplinary management the life of this mother could not be saved leaving behind her newborn baby with the father.Conclusion: Due to the rarity of the entity, the unpredictable nature and the multisystemic involvement, many health care providers as well as pregnant women may not be aware of the fatal consequences of this complication.

Endoscopic treatment of intermediate bronchus rupture in a 4-year-old child with polytrauma

BACKGROUND: In the structure of childhood traumatism, thoracic trauma occurs in less than 10% of cases, but it is the second most likely cause of death in children. A bronchial rupture that disrupts adequate ventilation of the lungs can be the culprit of the fatal outcome. The purpose of our publication is to demonstrate a rare clinical observation of successful endoscopic treatment of an intermediate bronchus rupture in a 4-year-old child with polytrauma. CLINICAL CASE DESCRIPTION: A 4-year-old boy was injured in a traffic accident as a pedestrian. During the first three days, he was treated for multiple injuries (Injury Severity Score 41) in a local hospital where, because of emergency indications, drainage of the right pleural cavity with two drains for tension pneumothorax and laparotomy for intra-abdominal bleeding due to liver rupture were done. Because of patient’s relative stabilization by the 3rd post-trauma day, he was transferred to our clinic (level 1 trauma center). We could stabilize his hemodynamics; however, air blowing through the drains was maintained, complete straightening of the parenchyma of the right lung was not reached, and blood gas composition remained subcompensated. On day 5 of the post-traumatic period, laryngotracheobronchoscopy was performed, and the rupture of intermediate bronchus measuring 3×9 mm was diagnosed. Its occlusion with a positive effect was done. After 7 days, laryngotracheobronchoscopy was repeated, and blockers were removed. After that, complete straightening of the right lung was reached; no recurrence of bronchopulmonary fistula. Long mechanical ventilation and long hospital stay were results of severe traumatic brain injury. At the follow-up visit in a year, no pathology in respiratory organs was detected at clinical laboratory, radiological and endoscopic examination. CONCLUSION: Bronchial rupture may be a cause of inadequate ventilation and aggravation of the post-traumatic period in a polytrauma patient. The present observation demonstrates that intraluminal endoscopy allows to timely detect the rupture of the large bronchus and to perform a minimally invasive surgical treatment. Such a tactics ensured further positive dynamics in child's condition and favorable outcomes after polytrauma, as a whole.

A case of spontaneous liver rupture and the role of imaging: from computed tomography to interventional treatment

Hepatic parenchymal rupture is a rare but potentially fatal condition that can be caused by trauma, iatrogenic factors, spontaneous causes, etc. This case report describes the diagnostic and therapeutic steps employed in a patient with spontaneous hepatic parenchymal rupture. An older woman came to the emergency department with diffuse stomach pain. After clinical evaluation, she underwent computed tomography. The first computed tomography did not reveal a full-blown parenchymal rupture. Owing to data ambiguity, indicating that the abdominal discomfort could be caused by renal or biliary colic, obtaining an early diagnosis was very difficult. In truth, only few hypodense oval shapes with characteristic suprafluid densitometry were found in the liver parenchyma. However, after a few days, the discomfort persisted, and as the condition worsened, the patient underwent additional radiological examinations, which revealed the rupture of the liver parenchyma that required arteriography, and a long hospital stay until clinical resolution.

Silencing of maternally expressed RNAs in Dlk1-Dio3 domain causes fatal vascular injury in the fetal liver

The mammalian imprinted Dlk1-Dio3 domain contains multiple lncRNAs, mRNAs, the largest miRNA cluster in the genome and four differentially methylated regions (DMRs), and deletion of maternally expressed RNA within this locus results in embryonic lethality, but the mechanism by which this occurs is not clear. Here, we optimized the model of maternally expressed RNAs transcription termination in the domain and found that the cause of embryonic death was apoptosis in the embryo, particularly in the liver. We generated a mouse model of maternally expressed RNAs silencing in the Dlk1-Dio3 domain by inserting a 3 × polyA termination sequence into the Gtl2 locus. By analyzing RNA-seq data of mouse embryos combined with histological analysis, we found that silencing of maternally expressed RNAs in the domain activated apoptosis, causing vascular rupture of the fetal liver, resulting in hemorrhage and injury. Mechanistically, termination of Gtl2 transcription results in the silencing of maternally expressed RNAs and activation of paternally expressed genes in the interval, and it is the gene itself rather than the IG-DMR and Gtl2-DMR that causes the aforementioned phenotypes. In conclusion, these findings illuminate a novel mechanism by which the silencing of maternally expressed RNAs within Dlk1-Dio3 domain leads to hepatic hemorrhage and embryonic death through the activation of apoptosis.

Prognostic analysis of 8 patients with hepatic adenoma undergoing allogeneic hematopoietic stem cell transplantation

Objective: To evaluate the safety of patients with hepatic adenoma undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: A retrospective analysis of the clinical characteristics and prognosis of eight patients with hepatic adenoma who underwent allo-HSCT in the Hematology Department of Peking University People's Hospital from January 2010 to March 2024 was conducted. Results: Of the eight patients who underwent allo-HSCT with hepatic adenoma, one patient was considered MDS-h transfusion-dependent and seven had aplastic anemia. The median age of the patients was 23 years (13-48 years). The median time from the diagnosis of AA or MDS to transplantation was 14 years (6-24 years), whereas the median time from taking androgens to diagnosing hepatic adenoma was 9 years (5-13 years). Six cases underwent haplo-HSCT, one case underwent matched unrelated donor HSCT, and one case underwent matched related donor HSCT. All patients achieved neutrophil engraftment at a median time of 11.5 days (11-20 days) and PLT engraftment within 60 days at a median of 19 days (10-37 days) after haplo-HSCT. Moreover, seven patients developed CMV anemia after transplantation, three patients had hemorrhagic cystitis, and two patients developed acute GVHD. During and after transplantation, eight patients did not show severe liver function damage or rupture of hepatic adenoma. In relation to imaging size, four patients showed varying degrees of reduction in hepatic adenoma size after transplantation, whereas four patients did not show significant changes in hepatic adenoma size after transplantation. The median follow-up time was 540.5 (30-2 989) days. Of the eight patients, six survived and two died. Furthermore, no direct correlation was observed between death and hepatic adenoma. Conclusion: Patients with hepatic adenomas undergoing allo-HSCT are not contraindications for transplantation, which will not increase transplant-related mortality.

Bronchobiliary fistula after traumatic liver rupture: a case report

IntroductionBronchobiliary fistulas are rare and difficult to treat. Peacock first reported this entity in 1850 while treating a patient with hepatic encopresis.Case presentationA 67-year-old Chinese male patient presented to the outpatient clinic with a complaint of coughing up phlegm with chest tightness for 4 days with symptoms of intermittent bilirubin sputum with a sputum volume of about 500 ml per day but no symptoms of abdominal pain or jaundice and no yellow urine or steatorrhea. The examination revealed cyanosis of the lips and mouth, barrel chest, low breath sounds on the right side, and a large number of wet rales heard in both lungs. The imaging investigations were suggestive of bronchobiliary fistula. Therefore, the patient was operated on and discharged with no perioperative complications.ConclusionBronchobiliary fistula should be considered diagnostically in patients with known liver disease who also experience trauma or medical treatment and cough up bile-colored sputum, regardless of the presence of concurrent infections, and in conjunction with radiological expertise to identify it. Here, we report a case of bronchobiliary fistula and a brief review of the literature on it.

Water-triggered shape memory cellulose / sodium alginate / montmorillonite composite sponges for rapid hemostasis

Uncontrollable bleeding caused by severe trauma is life-threatening. Therefore, it is of great significance to develop hemostatic materials that meet the rapid hemostasis of wounds. In this study, a water-triggered shape memory carboxylated cellulose nanofiber/sodium alginate/montmorillonite (CNSAMMTCa) composite hemostatic sponge was prepared, which can promote coagulation by concentrating the blood and activating intrinsic pathway. The anisotropic three-dimensional porous structure formed by directional freeze-drying technology improved the performance of composite sponges which showed good prospects in rapid hemostasis. The results showed that CNSAMMTCa composite sponge had good porous structure, water absorption ability, cytocompatibility and blood cell aggregation capacity. Simultaneously, we confirmed that CNSA3MMT2Ca has best coagulation performance in the mouse censored bleeding model and liver rupture bleeding model. Therefore, CNSAMMTCa composite hemostatic sponge is a safe and efficient rapid hemostatic material which is expected to become an alternative material for clinical hemostatic materials.

Liver rupture in patients with amyloidosis: Clinical features and treatment

Liver rupture in patients with amyloidosis: Clinical features and treatment

Kaolin loaded gelatin sponges for rapid and effective hemostasis and accelerated wound healing

Severe trauma with massive active blood loss, including liver and spleen rupture, arterial bleeding and pelvic fracture, will lead disability, malformation and even death. Therefore, it is very important to develop new, fast and efficient hemostatic materials. In this study, a novel Gelatin/Kaolin (GE/KA) composite sponge was developed. Meanwhile, to further investigate the effect of kaolin content on sponge properties, we prepared four types of sponges: GE/5% KA, GE/10% KA, GE/15% KA and GE/20% KA. The results of coagulation test in vitro showed that compared to the other groups, there were more activated adhered platelets and red blood cells on the surface of GE/15% KA. The results of hemostasis test in vivo showed that compared to other experimental groups, the GE/15% KA group had significantly less hemostasis time (liver hemostasis model: 69.50 ± 2.81 s; femoral artery hemostasis model: 75.17 ± 3.06 s) and bleeding volume (liver hemostasis model: 219.02 ± 10.39 mg; femoral artery hemostasis model: 948.00 ± 50.69 mg), and was similar to the commercial hemostasis material group. Additionally, the material properties of the sponge were characterized and its biocompatibility was verified as well through cell experiments and in vivo embedding experiments. All these results indicate that the optimal content of kaolin is 15%, which provides a theoretical basis for subsequent research. All in all, the novel GE/KA composite sponge prepared in this study can be used as a multifunctional hemostatic wound dressing for the treatment of complex wounds under various trauma scenes.

Progress in the hemostasis of traumatic liver rupture during interventional embolization

This paper mainly discusses the progress of hemostasis of traumatic liver rupture in interventional embolization. Traumatic liver rupture is a common intraabdominal traumatic disease in the clinic, and the incidence of right liver injury is generally high. The liver was located under the right diaphragm of the abdominal cavity, deep to both ribs. When subjected to external trauma or acute puncture, it can cause liver rupture and bleeding. If the liver is swollen due to lesions, the chance of liver rupture is relatively large. Severe hemorrhagic shock usually occurs after liver injury, causing bile peritonitis due to bile leakage into the abdominal cavity, and then infection occurs. How to improve the success rate of rescue has always been a difficult problem. This review described the pathological classification, classification and grading of liver rupture and combined with comprehensive studies of hemostatic materials at home and abroad to make a thorough analysis of vascular interventional embolization technique. The purpose of these analyses is to propose that embolization technology has good results for patients with liver rupture and bleeding, which can effectively reduce the disability rate and reduce complications, which is worth advocating clinically. Therefore, with the development of hemostatic materials science, the technology of hemostatic materials and related products has developed greatly, and the vascular interventional embolization technology has been widely improved in the clinical practice of surgery.

Application of percutaneous biliary drainage in the treatment of post-operative bile leakage after liver rupture: A case report.

Post-operative bile leakage (POBL) is a serious complication following hepatobiliary surgery, with potentially life-threatening consequences if left untreated. This article presents a successful case of POBL management without surgical intervention. A 31-year-old male, diagnosed with bile leakage before hospitalisation, underwent percutaneous biliary drainage (PTBD) to address bilomas. Follow-up after 3 months indicated biloma atrophy and POBL healing but revealed bile duct stenosis. The patient received a larger biliary drainage tube, and after 1 month, the biloma and tube were removed. A 1-year follow-up confirmed the patient's excellent health. This case underscores the safety and efficacy of PTBD for managing POBL, offering a non-invasive alternative for patients with this complication. PTBD presents a viable treatment option for POBL cases, minimising the need for surgical interventions and their associated risks.

Research on workflow recognition for liver rupture repair surgery.

Liver rupture repair surgery serves as one tool to treat liver rupture, especially beneficial for cases of mild liver rupture hemorrhage. Liver rupture can catalyze critical conditions such as hemorrhage and shock. Surgical workflow recognition in liver rupture repair surgery videos presents a significant task aimed at reducing surgical mistakes and enhancing the quality of surgeries conducted by surgeons. A liver rupture repair simulation surgical dataset is proposed in this paper which consists of 45 videos collaboratively completed by nine surgeons. Furthermore, an end-to-end SA-RLNet, a self attention-based recurrent convolutional neural network, is introduced in this paper. The self-attention mechanism is used to automatically identify the importance of input features in various instances and associate the relationships between input features. The accuracy of the surgical phase classification of the SA-RLNet approach is 90.6%. The present study demonstrates that the SA-RLNet approach shows strong generalization capabilities on the dataset. SA-RLNet has proved to be advantageous in capturing subtle variations between surgical phases. The application of surgical workflow recognition has promising feasibility in liver rupture repair surgery.

Experimental and morphological validation of Molselect G-50 sorbent for treating traumatic liver ruptures

Experimental and morphological validation of Molselect G-50 sorbent for treating traumatic liver ruptures

Idiopathic hepatic peliosis presenting as a spontaneous liver rupture

Idiopathic hepatic peliosis presenting as a spontaneous liver rupture

Treatment of a Patient With Closed Liver Injury Using Interventional Methods:
 a Case Study

Background. Mechanical injury occupies a leading position among the causes of mortality in the working-age population. Diagnosis and treatment of isolated and combined abdominal traumas accompanied by bleeding appear to be a specific challenge. Due to difficulties in diagnosis and treatment, they are characterized by frequent complications and an increased mortality rate.Currently, there is no uniform tactics for diagnosing and treating patients with liver damage. In Russia and globally, new approaches are being actively introduced for the treatment of patients with closed liver traumas using minimally invasive techniques.The aim of study was to present a clinical case of a patient with a closed liver injury treated using interventional methods, such as angiography and embolization.Materials and methods. According to conventional techniques, the patient had to undergo laparotomy with complex manipulations to stop intra-abdominal bleeding from a ruptured liver, which would inevitably worsen her condition in the context of a presenting severe injury.Multiple studies reported that the number of postoperative complications after laparotomy is up to 41%, and in case of combined trauma 10-35% of complications can be one of the causes of death [6, 7, 8]. In order to avoid more traumatic treatment approaches, we applied tactics using minimally invasive high-tech diagnostic and treatment options.Results. To stop intra-abdominal bleeding from a liver rupture, which was previously diagnosed during multislice computed tomography (MSCT) with intravenous contrast, using interventional options, selective embolization of the segmental branch of the right hepatic artery was performed with an adhesive composition. The post-traumatic period proceeded without complications; in 14 days after the injury, the patient was discharged in satisfactory condition.Conclusion. Minimally invasive and conservative treatment of patients with closed abdominal traumas using interventional radiology can be successfully applied in specialized trauma centers.

Factors affecting the outcome of liver trauma patients with non-operative management in the high care unit of Dr. Soetomo General Hospital Indonesia

Link of Video Abstract: https://youtu.be/V8nNXYUrFEY Background: The liver is the organ that experiences the most trauma when abdominal trauma occurs. Nonoperative management is the primary choice in patients with hepatic trauma with stable hemodynamics and no signs of peritonitis. Various factors that can affect outcomes Methods: This study is a cross-sectional design using medical record data. The study sample was all patients with liver trauma with nonoperative management who met the inclusion and exclusion criteria. The outcomes assessed were mortality and length of patient hospitalization. Data were analyzed using SPSS version 26.0 for Windows. Results: Over 2 years, 42 patients with liver trauma were treated for nonoperative management. Most patients were male (76.2%) with the age of < 30 years (54.8%). Motorcycle accidents were the most common mechanism (83.3%), with most experiencing grade 4 liver trauma (33.3%). Of the 42 patients, 36 patients (85.7%) were accompanied by trauma to other organs. One mortality was obtained from a total of 42 patients aged ≥ 60 years, grade 5, and accompanied by comorbidities. There was a significant association between age, liver rupture grade, and comorbidity injuries and mortality in patients (p = 0.001; p = 0.01; p = 0.0001). From the outcome of the length of hospitalization, there is a relationship that tends to be significant between the presence of comorbidity trauma and the length of hospitalization (p = 0.061) Conclusion: Mortality in liver trauma patients with nonoperative management was influenced by age, liver rupture grade, and accompanying injuries. Meanwhile, the length of hospitalization is only affected by comorbidities.

Preeclampsia and HELLP syndrome complicated by subcapsular liver hematoma and rupture.

Preeclampsia and HELLP syndrome complicated by subcapsular liver hematoma and rupture.

Crosslinked chitosan/γ-polyglutamic acid sponge carrying berberine for hemostasis and wound healing

Wound healing material with good hemostatic ability is urgently needed in clinical. Herein, we prepared a crosslinked chitosan/γ-polyglutamic acid sponge loading berberine (CPG-B3) for hemostasis and wound healing. The CPG-B3 sponge could absorb a large number of water in the bleeding point, which led to the accumulation of various blood coagulation factors and quick hemostasis. The presence of berberine enhanced the antibacterial activity of CPG-B3. In vitro biological investigations indicated that CPG-B3 showed low hemolysis ratio, the proliferation and migration of L929 cells incubated with CPG-B3 were not affected. In vivo studies revealed that CPG-B3 showed good hemostatic ability in a liver rupture bleeding model, and could accelerate the bacterial-infected wound healing process. Overall, the sponge shows great potential as hemostatic and wound healing material.

The role of laparoscopy in closed abdominal injury

ObjectiveTo investigate the effect of laparoscopy on the diagnosis and treatment of closed abdominal injury. MethodsA total of 26 patients with closed abdominal injury admitted to our hospital from January 2016 to January 2019 were searched. All patients were treated by laparoscopy. All patient reports were made with the informed consent of the patients. ResultsAll patients were diagnosed clearly during operation. Among them, there were 3 cases of gastric perforation, 2 cases of liver rupture, 13 cases of spleen rupture, 3 cases of small intestine rupture, 1 case of liver round ligament laceration, 2 cases of small mesenteric vascular laceration, 1 case of colon liver mesenteric laceration, and 1 case of retroperitoneal hematoma. Of the 26 patients in this group, 23 (88.5%) completed laparoscopically or laparoscopically assisted; 5 cases (19.3%) only performed laparoscopic exploration without special treatment, and 3 cases (11.5%) switched to laparotomy. The blood loss was 50–2000 ml (mean 500 ml), and the operative time was 60–180min (mean 128min). The length of hospital stay was 3–21 d (mean 9 d). There were no complications or deaths related to laparoscopy in the whole group. Conclusion Laparoscopic technique has the advantages of less trauma, high diagnosis rate and fast recovery. It can also be used for surgical treatment in the diagnosis and treatment of closed abdominal injury, so as to achieve the purpose of comprehensive diagnosis and treatment. The limitations of laparoscopy should also be noted.

Report of a case of liver rupture in preeclampsia and HELLP syndrome

Report of a case of liver rupture in preeclampsia and HELLP syndrome