Liver Rupture Research Articles

Liver Rupture in Preeclampsia Complicated by HELLP Syndrome, A Case Report

Pre-eclampsia remains a common pregnancy disorder with a high maternal and neonatal mortality and morbidity. It affects 2–5% of pregnancies, and occurs most commonly at term

Adhesive cryogel particles for bridging confined and irregular tissue defects

BackgroundReconstruction of damaged tissues requires both surface hemostasis and tissue bridging. Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies, making tissue bridging challenging.MethodsThis study proposes a tissue adhesive in the form of adhesive cryogel particles (ACPs) made from chitosan, acrylic acid, 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS). The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart, intestine, liver, muscle, and stomach. Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells (LO2) and human intestinal epithelial cells (Caco-2). The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models. The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart, liver, and kidney as the ex vivo models. Furthermore, a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness, biocompatibility, and applicability in clinical surgery.ResultsACPs are applicable to confined and irregular tissue defects, such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs. ACPs formed tough adhesion between tissues [(670.9 ± 50.1) J/m2 for the heart, (607.6 ± 30.0) J/m2 for the intestine, (473.7 ± 37.0) J/m2 for the liver, (186.1 ± 13.3) J/m2 for muscle, and (579.3 ± 32.3) J/m2 for the stomach]. ACPs showed considerable cytocompatibility in vitro study, with a high level of cell viability for 3 d [(98.8 ± 1.2) % for LO2 and (98.3 ± 1.6) % for Caco-2]. It has comparable inflammation repair in a ruptured rat liver (P = 0.58 compared with suture closure), the same with intestinal anastomosis in rabbits (P = 0.40 compared with suture anastomosis). Additionally, ACPs-based intestinal anastomosis (less than 30 s) was remarkably faster than the conventional suturing process (more than 10 min). When ACPs degrade after surgery, the tissues heal across the adhesion interface.ConclusionsACPs are promising as the adhesive for clinical operations and battlefield rescue, with the capability to bridge irregular tissue defects rapidly.

Atraumatic Spleen and Liver Rupture While Weightlifting during Epstein-Barr Virus Convalescence.

In Brief A case of spleen and liver rupture while weightlifting suggests the need for additional activity restrictions during Epstein-Barr virus convalescence.

Bilateral primary angiosarcoma of the breast: a case report

BackgroundPrimary angiosarcoma of the breast is very rare, accounting for 0.05% of all malignant breast tumors. It has very high malignant potential and poor prognosis, though due to the rarity of the disease, there is no established treatment. We report this case along with a literature review.Case presentationWe report the case of a 30-year-old Asian woman who was diagnosed with bilateral primary angiosarcoma of the breast while breastfeeding. After surgery, she underwent radiation therapy, chemotherapy, and hepatic arterial infusion chemotherapy for local recurrence of liver metastases, but these were ineffective, and she required several arterial embolization procedures for intratumoral bleeding and rupture of liver metastases.ConclusionsAngiosarcoma has a poor prognosis due to a high rate of local recurrence and distant metastasis. Although there is no established evidence for radiotherapy or chemotherapy, multimodality treatment may be necessary because of the high malignancy and rapid progression of the disease.

Construction of a nomogram predictive model for patients with liver rupture undergoing surgical intervention.

The incidence of blunt abdominal injury has significantly increased, and the liver is one of the most commonly damaged organs. In this study, we explored and established a nomogram model for patients with liver ruptures undergoing surgical treatment. A retrospective analysis was conducted for 66 adult patients with liver rupture, who were admitted to our hospital from January 2011 to October 2018. These patients were classified into two groups, according to whether the patient had surgery: surgery group (41 cases) and non-surgical group (25 cases). The following data were collected from these two groups of patients: gender, age, injury mechanism, liver damage, laboratory test results, and hospitalization. Multivariate logistic regression analysis was performed to screen the risk factors of patients who require surgical treatment, establish a predictive model based on the selected indicators, and draw the nomogram. Receiver operating characteristic curves and the calibration curve were used to evaluate the predictive value of the model. Compared to the non-surgical group, the body temperature decreased, the heart rate increased, the injury severity score grade increased, the blood urea nitrogen, blood uric acid, creatinine (Cr), arterial partial pressure of oxygen, alkali excess, blood lactic acid and creatine kinase isoenzymes MB (CK-MB) increased, and the HCO- and Glasgow Coma Scale (GCS) coma scores decreased for patients in the surgical group (all, p<0.05). The logistic regression analysis revealed that Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, and the Glasgow coma score were the influencing factors for surgical intervention for liver rupture. The nomo-gram model constructed based on these five indicators had a good degree of discrimination (area under the curve = 0.971, 95% CI: 0.896-0.997) and accuracy. A nomogram model established based on Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, the GCS, and other parameters can accurately predict the surgical treatment of patients with liver rupture.

Forensic characteristics of injuries in cyclists in collisions with other vehicles

In order to identify the features of the injuries formation in cyclists who were injured in a collision of moving vehicles with a blow to the rear wheel area of a bicycle moving at a slower speed in the same direction, the authors analyzed the results of forensic medical examinations in relation to 151 corpses of cyclists who died in road accidents aged 4 to 74 years. It was found that with this type of bicycle injury, the structures of the head, chest, lower extremities, as well as the structures of the abdomen were most often injured. Injuries to the structure of the head were characterized by the formation of depressed-comminuted fractures: more often frontal-temporal, less often occipital bone. Bilateral fractures of the ribs were also quite frequent types of damage, mainly the upper ribs (up to 5-6 ribs) were damaged, most often along the midclavicular and anterior axillary lines. Lung contusions have been identified in most of the injured persons with chest structure injury. Injuries to the abdominal organs and retroperitoneal space were recorded in 22.27% of cases, with liver and spleen ruptures in the majority of cases. Spinal injuries in cyclists were detected in 13.25% of cases, injuries in the cervical spine prevailed: cervico-occipital injuries and fracture-dislocations, mainly between 1-2 and 3-4 or 6-7 cervical vertebrae with separation or contusion of the spinal cord. Injuries to the structure and organs of the pelvis in road accidents in cyclists were observed very rarely, which made it possible to distinguish this type of bicycle injuries from other types of transport and blunt injuries, in particular from automobile injuries. Injuries to the structure of the limbs of the victims were noted quite often: fractures of the upper limbs occurred when falling on the road surface and injury to the lower limbs was formed both during the contact of two vehicles and when the victims fell on the road surface.

Hemostasis for central rupture of liver in a child

Blunt abdominal trauma in children accompanied by liver damage occurs in 18-20% of cases. Endovascular embolization is the most common approach for bleeding following central ruptures of liver. Foreign authors published few case reports devoted to successful embolization for central liver ruptures in children. In Russian-language literature, there is one similar report with complicated postoperative period. We present a child with class II blunt liver injury, marginal rupture and central hematoma. The patients underwent suturing of marginal rupture and endovascular embolization without postoperative complications.

Acute Abdomeninal Pain Developed Due to Hydatic Rupture of Liver and Spleen Cyst at Different Times: A Very Rare Case

Acute Abdomeninal Pain Developed Due to Hydatic Rupture of Liver and Spleen Cyst at Different Times: A Very Rare Case

Characteristics of injuries in cyclists injured when other vehicles collide with the side of the body of moving bicycles

BACKGROUND: Bicycle injuries, as a separate type of traffic accidents, require forensic medical examinations to establish the mechanism, duration, and severity of injuries. Forensic medical aspects of cycling injuries are insufficiently covered in the literature.&#x0D; AIM: To study the nature and features of the injury formation in cyclists who sustained injured when other vehicles hit the side of the moving bicycle.&#x0D; MATERIALS AND METHODS: The results of forensic medical examinations of 51 cyclists who died when the moving bicycles collided with the side of vehicles.&#x0D; RESULTS: The most frequently observed injuries in cyclists are traumatic brain injury (21.56%) and combined injuries, namely, head and chest (15.68%), lower extremities with trauma to the head, and chest (11.76%). Nearly all deceased cyclists sustained damage to the head (96.0%), which was characterized by the formation of a severe contusion of the brain with fractures of the parietotemporal and occipital bones. Damage to the chest and chest cavity organ was also observed frequently (50.69%). Rib fractures were noted in 74.2% of cases. Injuries to the abdominal organs were detected in 20.15% of the cases, such as liver rupture and hemorrhage in the ligaments of organs. Diaphyseal comminuted fractures of the bones of the lower leg and femur were also observed.&#x0D; CONCLUSION: The most common types of injuries in deceased cyclists in a side collision of other vehicles with a moving bicycle are traumatic brain injury and combined injuries of the head, chest, and fractures of the bones of the lower extremities in combination with a head and chest injury. Damage to the head was characterized by the formation of linear, depressed, and comminuted fractures of the parietaltemporal and occipital bones. Damage to the chest was characterized by fractures of the upper ribs and bruises of the lungs. Damage to the skin, resembling a picture of a road rash, was noted on the anterolateral body parts.

Rare Types of Spontaneous Liver Ruptures During Pregnancy

This literature review is devoted to the problem of spontaneous liver ruptures in pregnant women. Its goal was to raise awareness among physicians as one of the methods to improve the early diagnosis of the disease, as well as to consider the role of the hepatological surgeon in the surgical treatment of rare obstetric diseases. The main links of the pathogenesis of liver ruptures were considered, the problem of high maternal and perinatal mortality was disclosed. Based on the literature data, the most optimal obstetric and surgical treatment and diagnostic tactics for managing pregnant women with spontaneous liver ruptures were determined.

P181 Mucor in the land of the liver: a case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction and ObjectivesMucormycosis is a rare, highly lethal opportunistic fungal infection affecting immune-compromised patients. It accounts for about 2% of invasive fungal infections occurring within 1 year after solid organ transplantation. Among renal recipients, Rhinocerebral is the commonest manifestation and Rhizopus species is the most frequent pathogen.The objectives are:To report a case of Hepatic mucormycosis in a renal transplant recipient.To resolve the dilemma in identification of Mucorale species detected on microscopy but culture negative.MethodA 29-year-old male patient was admitted with severe abdominal pain on day 28 post-live related renal transplantation. Patient was hypertensive, on oral steroids for idiopathic thrombocytopenic purpura, chronic kidney disease with venous thromboembolism-presumed chronic interstitial nephritis, and maintained on hemodialysis for the last 1 year. Post-transplant he was on triple immunosuppressants.Initial ultrasound of abdomen and transplant doppler were normal. CT of abdomen in view of worsening hypotension and non-resolving abdominal pain, revealed hepatomegaly with multiple discrete, coalescing hypodense areas in both lobes of liver with minimal subcapsular extension. Initial cultures included interventional radiology-guided liver aspirate and blood culture. Patient was started on antibiotics and antifungals. Patient continued to deteriorate and a repeat abdominal CT revealed an increase in liver size and rupture of liver abscess. Sample collected on pigtail catheter insertion was also sent for culture.ResultsThe pus aspirate was received for bacterial and fungal culture. Aerobic bacterial culture yielded Klebsiella species. Examination with KOH Calcofluor revealed broad aseptate fungal hyphae. However, fungal culture did not yield any growth. Pain resistant (PDR) Klebsiella species was isolated from blood culture. Pigtail catheter sample also yielded the same. Aseptate fungal hyphae were observed in the pigtail catheter sample also. The team decided on conservative management and patient was started on intravenous amphotericin B deoxycholate(50 mg/day), tigecycline, and meropenem. Immunosuppressants were withheld. The clinical course worsened and the patient succumbed to illness after 18 days of antifungal therapy. The pus sample was then sent to the referral center PGIMER for PCR and sequencing where it was identified as Lichtheimia species.ConclusionMucormycosis is an increasingly emerging invasive fungal infection especially in immune-compromised patients, including solid organ transplant recipients. Though uncommon it is frequently a fatal mycosis in transplant patients. Hepatic mucormycosis in renal transplant recipients has been reported in three patients so far. None are due to Lichtheimia species. The diagnosis of hepatic mucormycosis was confirmed as microscopy was positive in two successive samples. Our patient also had bacteremia with PDR Klebsiella.Diagnosis is challenging and often delayed, as the clinical presentation is non-specific. Although mucormycosis in a renal transplant recipient is rare, a high index of suspicion and critical microscopic examination is warranted for early initiation of specific therapy which includes liposomal amphotericin B and surgery. Often cultures yield no growth and gene sequencing proves to be efficient and time-saving. This probably is the way ahead, especially for culture-negative samples to establish the etiological diagnosis.

Placental growth fActor Repeat sampling for Reduction of adverse perinatal Outcomes in women with suspecTed pre-eclampsia: study protocol for a randomised controlled trial (PARROT-2)

BackgroundPre-eclampsia is a complex pregnancy disorder, characterised by new or worsening hypertension associated with multi-organ dysfunction. Adverse outcomes include eclampsia, liver rupture, stroke, pulmonary oedema, and acute kidney injury in the mother, and stillbirth, foetal growth restriction, and iatrogenic preterm delivery for the foetus. Angiogenic biomarkers, including placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1), have been identified as valuable biomarkers for preterm pre-eclampsia, accelerating diagnosis and reducing maternal adverse outcomes by risk stratification, with enhanced surveillance for high-risk women. PlGF-based testing for suspected preterm pre-eclampsia has been incorporated into national guidance. The role of repeat PlGF-based testing and its effect on maternal and perinatal adverse outcomes have yet to be evaluated.MethodsThe PARROT-2 trial is a multi-centre randomised controlled trial of repeat revealed PlGF-based testing compared to repeat concealed testing, in women presenting with suspected pre-eclampsia between 22+0 and 35+6 weeks’ gestation. The primary objective is to establish whether repeat PlGF-based testing decreases a composite of perinatal severe adverse outcomes (stillbirth, early neonatal death, or neonatal unit admission). All women prior to enrolment in the trial will have an initial revealed PlGF-based test. Repeat PlGF-based tests will be performed weekly or two-weekly, depending on the initial PlGF-based test result, with results randomised to revealed or concealed.DiscussionNational guidance recommends that all women presenting with suspected preterm pre-eclampsia should have a single PlGF-based test when disease is first suspected, to help rule out pre-eclampsia. Clinical and cost-effectiveness of repeat PlGF-based testing has yet to be investigated. This trial aims to address whether repeat PlGF-based testing reduces severe maternal and perinatal adverse outcomes and whether repeat testing is cost-effective.Trial registrationISRCTN 85912420. Registered on 25 November 2019

Patho-mechanical comparative morpho-characterization of contre-coup injuries of liver by cadaveric experimental simulation for medico-legal and forensic implications

BackgroundLiver is the most common organ to get injured in cases of blunt force trauma to the abdomen (BFTA). It is the 2nd commonest organ after brain to sustain injuries out of all the trauma related fatalities. However, the literature about contre-coup injuries to the liver due to BFTA is scarce in-spite of the high mortality rates seen out of injury to this particular organ. PurposeThe authors intended to systematize the characteristic morphogenesis of the contre-coup injuries of the liver on the basis of the patho-mechanics involved in various types of BFTA. MethodologyOne hundred and sixty three cases of BFTA were identified, and interpretation was attempted for the contre-coup rupture of the liver seen in twenty out of all the trauma related fatalities that presented for post-mortem examination during the study period. However, the mechanics of the pattern of the rupture injuries to the liver were indiscernible. This motivated the authors to conduct the comparative characterization of injuries to the liver by experimental simulation of BFTA after necessary permission via inflicting pre-calculated forces on unclaimed cadavers. ResultsThe patterns of contre-coup rupture/s of liver were established in all the twenty out of one sixty-three cases of BFTA. The rupture depicted patterns of injury in the situations of - 1) strong hits with a limited surface trauma, 2) very strong hits with a generalized surface trauma, 3) and collision with a solid surface resulting due to fall onto the side of the abdomen. The causative mechanism discerned was deformation of the liver, followed by its parenchymal rupture due to the shear and strain types of force/s consequent upon tissue compression. The minimum force and energy of impact required for the liver to rupture was estimated to be 2000 N and 141.5 J. ConclusionThis series of the simulation experiments revealed two variants of liver rupture in the contre-coup impact zone. The pattern of injury was maintained in cases, those studied at post-mortem examinations, but the relief ruptures were found to vary depending upon the overall mechanics of the traumatic forces involved in the simulation experiments performed on the cadavers. The anti-shock ruptures were formed during shock trauma, and shockproof ruptures were not seen in cases of underlying compressive forces. The morphogenetic characterization of the relief rupture surface of the liver was also delineated in relation to its surface orientation to the spine on the basis of the terms “large” and “very large” depicting the quantum of force/s delivered out of an impact or blow.

Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases

BackgroundSpontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood. The goal was to summarize and define the etiology, risk factors, clinical presentation, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupture during pregnancy/puerperium (SHRP) complicated by the hypertensive disorder.MethodsLiterature search of all full-text articles included PubMed (1946–2021), PubMed Central (1900–2021), and Google Scholar. Case reports of a spontaneous hepatic rupture or liver hematoma during pregnancy or puerperium as a complication of hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) were searched. There was no restriction of language to collect the cases. Additional cases were identified by reviewing references of retrieved studies. PRISMA guidelines for the data extraction and quality assessment were applied.ResultsThree hundred and ninety-one cases were collected. The median maternal age was 31 (range 17–48) years; 36.6% were nulliparous. Most (83.4%) occurred in the third trimester. Maternal and fetal mortality was 22.1% and 37.2%, respectively. Maternal and fetal mortality was significantly higher 1) before the year 1990, 2) with maternal hemodynamic instability, and 3) eclampsia. The most important risk factors for SHRP were preeclampsia and HELLP syndrome. Most women had right lobe affected (70.9%), followed by both lobes in 22.1% and left lobe in 6.9%. The most common surgical procedure was liver packing. Liver transplantation was performed in 4.7% with 100% survival. Maternal mortality with liver embolization was 3.0%. Higher gestational age increases fetal survival.ConclusionThe diagnosis and treatment of SHRP are often delayed, leading to high maternal and fetal mortality. SHRP should be excluded in hemodynamically unstable patients with preeclampsia/eclampsia or HELLP syndrome and right upper abdominal pain. Liver embolization and liver transplantation contribute to maternal survival. Maternal and fetal mortality was significantly higher before the year 1990. Hemodynamic instability, preeclampsia, and eclampsia have a significant negative influence on maternal survival.Level of evidenceLevel V

Hemoperitoneum Following Liver Rupture in a Post ERCP Patient: A Case Report

Hemoperitoneum Following Liver Rupture in a Post ERCP Patient: A Case Report

Salvage 125I brachytherapy for liver metastases of colorectal cancer in anatomically challenging locations after failure of systemic chemotherapy—A retrospective study

Colorectal cancer liver metastasis (CCLM) in anatomically challenging locations is difficult to treat. This retrospective study aimed to evaluate the effectiveness and safety of permanent 125I seeds implantation (ISI) for treatment of CCLM in anatomically challenging locations after failure of systemic chemotherapy. A total of 31 liver metastases (in 25 patients) were treated by ISI under computerized tomography guidance from January 2011 to December 2017. Post-treatment follow-up was for 40 months. Adverse events were classified using the National Cancer Institute's Common Terminology Criteria for Adverse Events. Tumor response was evaluated by the mRECIST criteria. Objective response rate, overall survival rate, and complications were retrospectively analyzed. All ISI procedures were performed successfully. Most patients only complained of fatigue and mild pain after ISI. Only one patient had liver rupture during the procedure. Serum alanine aminotransferase and aspartate aminotransferase levels at 1 month after ISI were not significantly different from pre-procedure levels (p > 0.05). Computed tomography at 6 months after ISI treatment showed completed response in 11 (11/31, 35.5%) lesions, partial response in 14 (14/31, 45.2%) lesions, stable disease in 4 (4/31, 12.9%) lesions, and disease progression in 2 (2/31, 6.5%) lesions; thus, the objective response rate was 80.6%. Median survival was for 12 months. The 1 and 2 year overall survival rates were 52.0% and 20.0%, respectively. 125I seeds implantation for CCLM in anatomically challenging locations is safe and effective. Survival benefit is limited in the salvage setting where patients have high intrahepatic tumor load after failed systemic chemotherapy.

Spontaneous liver rupture following SARS-CoV-2 infection in late pregnancy: A case report

BACKGROUNDCoronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by systemic inflammatory response syndrome and vasculopathy. SARS-CoV-2 associated mortality ranges from 2% to 6%. Liver dysfunction was observed in 14%-53% of COVID-19 cases, especially in moderate severe cases. However, no cases of spontaneous hepatic rupture in pregnant women with SARS-CoV-2 have been reported.CASE SUMMARYA 32-year-old pregnant patient (gestational age: 32 wk + 4 d) without any remarkable medical history or long-term medication presented with epigastralgia. Infectious, non-infectious, and pregnancy-related hepatopathies were excluded. Sudden onset of right subcostal pain with D-dimer and liver enzyme elevation was followed by shock with thrombocytopenia. While performing an emergency cesarean section, hemoperitoneum was observed, and the patient delivered a stillbirth. A 6-cm liver rupture at the edges of segments V and VI had occurred, which was sutured and drained. SARS-CoV-2 positivity on reverse transcription-polymerase chain reaction was confirmed. Further revisions for intrahepatic hematoma with hemorrhagic shock and abdominal compartment syndrome were performed. Subsequently, the patient developed hemoptysis, which was treated using bronchoscopic therapy and non-invasive ventilation. Liver tissue biopsy revealed hemorrhagic foci and necrosis with an irregular centrilobular distribution. Antiphospholipid syndrome and autoimmune hepatitis were also ruled out. Fetal death was caused by acute intrauterine asphyxia.CONCLUSIONThis case reveals that pregnant women with SARS-CoV-2 infection may be predisposed to liver parenchyma disease with liver rupture.

The Role of Focused Assessment with Sonography for Trauma (FAST) in Children with Stable Hemodynamics after Blunt Abdominal Trauma:the Spleen and Hepatic Rupture Case Series

Introduction: The most prevalent type of abdominal trauma in children is blunt abdominal trauma (BAT). Traffic accidents and falls are the most prevalent causes of trauma. In this case, a CT scan is the gold standard for detecting BAT. However, there are several limits to this examination, particularly in terms of availability, cost, and radiation exposure. In BAT, FAST assists in the detection of intraabdominal free fluid. Case Description: Three pediatric patients with stable hemodynamics underwent BAT in this case series. All three patients were below 17 years old and had stomach discomfort due to a traffic accident. All three patients tested positive for FAST. Then, a contrast CT scan of the abdomen revealed a splenic rupture in the three patients and a splenic rupture and liver rupture in one of them. All the patients were hemodynamically stable before being treated with symptomatic medicines in a conservative (non-surgical) manner. All of the patients had satisfactory outcomes and could return home without undergoing surgery. Conclusion: Both FAST and CT scans do not affect therapeutic care, that were conservative management in these patients with stable hemodynamics. As a result, FAST may be a less expensive examination alternative, reducing radiation exposure and lowering the risk of cancer in children in the future.

Spontaneous rupture of hemorrhagic hepatic cyst: two case reports

BackgroundSpontaneous rupture of a hemorrhagic hepatic cyst is extremely rare. There is no standard treatment recommended for this condition. We report two cases of hemorrhagic hepatic cysts that spontaneously ruptured and were successfully treated with laparoscopic deroofing. We review the literature and discuss the characteristic features of spontaneous rupture of hemorrhagic hepatic cysts and their treatment.Case presentationThe first patient was an 85-year-old man admitted for sudden-onset right hypochondralgia and fever. Computed tomography revealed a 13-cm hepatic cyst occupying the right lobe of the liver and spontaneous rupture of the cyst. Laparoscopic deroofing was performed and continuous oozing from the cystic wall was found. Histological examination revealed a simple hepatic cyst. The patient was discharged on postoperative day 6. In the second case, a 77-year-old woman who had been followed up for a simple hepatic cyst (13 cm) was admitted for sudden onset of right hypochondralgia. Computed tomography demonstrated a 9.9-cm hepatic cyst occupying segment 4 of the liver. Laparoscopic deroofing was performed and continuous oozing from the cystic wall was observed. Histological examination revealed a simple hepatic cyst. The patient was discharged on postoperative day 6.ConclusionLaparoscopic deroofing was performed in patients with spontaneous rupture of hemorrhagic nonparasitic hepatic cysts.

Treatment of closed injuries of the liver and spleen

Among closed abdominal injuries, liver ruptures are the most severe, surgical treatment of which still gives high mortality (with isolated injuries, according to B.P. Levitsky - 41.7%, A.A.Korolev - 50%, G.F. Nikolaev 15%, SV Lobachev and OI Vinogradova 12.5%), and when combined with damage to other organs, the lethality reaches 50-90%.