Spontaneous Hepatic Hemorrhage Research Articles

Spontaneous hepatic hemorrhage as presentation of metastasized papillary thyroid carcinoma: a case report

BackgroundSpontaneous hepatic hemorrhage is a rare condition, most commonly diagnosed in patients with hepatocellular carcinoma or hepatic adenomas, and is seldom caused by metastatic disease. In this case report, we present a patient with spontaneous hepatic hemorrhage due to hepatic metastasis of papillary thyroid carcinoma, an exceptionally rare occurrence.Case presentationThe patient was a 77-year-old white male with a history of atrial fibrillation treated with apixaban. He presented at a local hospital with abdominal pain and nausea. A CT scan revealed a hepatic lesion in segment 3 with an adjacent hematoma. He was referred to our tertiary center and treated conservatively. Further evaluation revealed an intrathoracic goiter containing a tumorous process diagnosed as a papillary thyroid carcinoma (PTC), and the patient subsequently underwent thyroidectomy. A biopsy of the hepatic lesion confirmed it as a PTC metastasis. Due to worsening abdominal pain and anorexia, the patient underwent subacute hepatic segmental resection. Postoperatively, he developed iodine-refractory disease with disseminated metastasis and passed away 22 months after the initial admission.ConclusionsTo our knowledge, this is the first recorded case of metastasized papillary thyroid carcinoma presenting with spontaneous hepatic hemorrhage—adding to the list of rare causes for this condition.

Spontaneous hepatic haemorrhage after caesarean section in a patient with uraemia and superimposed preeclampsia: a case report

Perinatal spontaneous hepatic haemorrhage is a very rare disease affecting pregnant women, particularly those on long-term dialysis, that has a high maternal and infant mortality rate. Most patients experience preeclampsia with haemolysis, elevated liver enzymes and low platelets syndrome. Here, the case of a 35-year-old multigravida patient with known chronic kidney disease and chronic hypertension with uraemia, who developed spontaneous hepatic haemorrhage after caesarean section, is described. The patient experienced sudden massive circulatory failure, but hemodynamics were temporarily stabilized after emergency surgery. Following transfer to the intensive care unit for continued treatment, her blood pressure and haemoglobin level continued to drop. Selective hepatic artery embolization was performed on day 2 after delivery, and her vital signs gradually stabilized. On day 30 after delivery, the patient was discharged in a stable condition. The newborn recovered after therapy in neonatal intensive care for 2 months. The present case suggests that, for perinatal spontaneous hepatic haemorrhage, timely and accurate diagnosis, multidisciplinary management and determining the therapeutic approach according to clinical symptoms are essential.

Hemorragia hepática espontánea como causa inusual de abdomen agudo hemorrágico

Spontaneous hepatic hemorrhage (SHH) is a rare condition resulting from a breach in the hepatic parenchyma that occurs without an external cause. We report the case of a 74-year-old woman who, while being hospitalized due to exacerbation of chronic obstructive pulmonary disease (COPD), presented an episode of SHH with hemorrhagic shock. She underwent atypical resection of a hepatocellular carcinoma (HCC) with active bleeding in liver segment III. The patient had a favorable response to the initial treatment but died in the intensive care unit (ICU) on postoperative day 16 due to a respiratory tract complication.

S2578 Massive Hepatomegaly on Arrival From Mexico: Keep the Differential Broad

INTRODUCTION: Amyloidosis is a broad term used to denote the extracellular deposition of protein fibrils in various organs, the most common being light chain amyloid (AL) or primary amyloidosis. Amyloidosis can affect any organ system and commonly manifests with organomegaly, cardiomyopathy and renal failure. The diagnosis is made by tissue biopsy staining positive for Congo red. The relative infrequency and wide variations in clinical presentation can make amyloidosis a difficult diagnosis. CASE DESCRIPTION/METHODS: A 52-year-old male who recently immigrated from Mexico, with a past medical history of hypertension, gout and recently diagnosed kidney disease presented with complaints of 20 lb weight loss and generalized malaise over the last three months. He had recently been started on corticosteroids in Mexico, which he was told was for abnormal kidney function. The patient appeared cachectic and exhibited diffuse abdominal tenderness with a palpable abdominal mass and bilateral lower extremity edema. Vital signs were within normal limits. Labs were remarkable for hemoglobin 11.0 g/dL, BUN 117 mg/dL, creatinine 5.27 mg/dL, alkaline phosphatase 305 U/L, GGT 734 U/L, AST 66 U/L and ALT 66 U/L. He also had nephrotic range proteinuria. CT of the abdomen showed hepatomegaly with a 3 × 4 cm mass, likely a hemangioma, which was unable to be confirmed by subsequent MRI, due to lack of contrast. In light of recent immigration, the differential diagnosis was even broader than normal. The patient was started on a diuretic regimen with good response and underwent a bone marrow and kidney biopsy during the admission. Bone marrow biopsy showed a plasma cell neoplasia positive for amyloidosis. Kidney biopsy showed positive Congo red stain with characteristic apple green birefringence under polarized light and positive staining for lambda without kappa. These findings were diagnostic for AL amyloidosis. The patient was later started on a chemotherapy regimen of cyclophosphamide, bortezomib and dexamethasone with plan for autologous bone marrow transplantation. DISCUSSION: We present a rare case of AL amyloidosis presenting with multi-organ failure. A high degree of clinical suspicion is needed in diagnosing amyloidosis, to decrease delays in treatment and avoid life threatening complications like spontaneous hepatic hemorrhage. This case highlights the various presentations of amyloidosis with potential confounders that can delay diagnosis such as a concurrent hepatic mass and recent immigration from Mexico.Figure 1.: Congo red stain of kidney showing amyloid deposition in glomeruli, ×10.Figure 2.: Jones stain showing accumulation of amyloid within the glomeruli, ×20.

Polyarteritis Nodosa – Risk of Stopping Immunosuppressent and a Rare Fatal Complication

Background: Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis which can cause multifocal aneurysms of visceral arteries, which may rupture causing haemorrhage, thrombosis, organ ischemia and infarction While the treatment of vasculitis requires long term use of immunosuppressive drugs, these patients are more prone for diseases like tuberculosis due to decreased cell mediated immunity. Case presentation: Hepatic involvement in PAN is not common and many of the fi ndings are occult. A 40 year old lady, a known case of polyarteritis nodosa on treatment with steroid and immuno-suppressants for the last 18 years, with history of multiple episodes of relapse of the vasculitis, and cyclophosphamide induced ovarian failure on hormone replacement therapy was diagnosed to be having sputum positive tuberculosis. She was initiated on anti-tuberculosis treatment. Vasculitis was on remission for the last 12 months. So Mycophenolate Mofetil was stopped as per the advice of the Rheumatologist. 14 days later she developed abdominal pain with dropping hemoglobin. CT angiography showed ruptured liver hematoma with hemoperitoneum and she succumbed to her illness. Conclusion: Spontaneous hepatic hemorrhage, probably due to a ruptured hepatic artery aneurysm is a rare complication which is reported, only a very few times in the literature so far. This case report throws light on the possible detrimental outcomes in stopping immunosuppressive drugs, especially in a patient with multiple episodes of relapse in the past, in the background of an ongoing infection like tuberculosis. Continuation of the immunosuppressive drugs need to be considered against it’s stoppage in high risk patients.

Transcatheter arterial embolization in hepatic tumor hemorrhage

Objective: Spontaneous hepatic tumor hemorrhage is a rare but challenging emergency especially among cirrhotic patients with poor hepatic function. This study aimed at analyzing the safety, efficacy and feasibility of transcatheter arterial embolization (TAE) in the treatment of hepatic tumor hemorrhage.Methods: This retrospective study included all patients undergoing embolization attempt for hepatic tumor hemorrhage in the Helsinki University Hospital during 2004–2017. Electronic medical records provided the study data. Outcomes included the 30-day rebleeding, complication and mortality rates, need for blood transfusions, durations of intensive care unit and hospital admissions, estimates of overall survival, and analysis of factors associated with 30-day mortality.Results: During the study period, 49 patients underwent angiography for hepatic tumor hemorrhage. TAE was technically feasible in 45 patients (92%), and controlled the bleeding with the first attempt in 84%. The 30-day complication and mortality rates were 57 and 33%, respectively. Major complications occurred in 33% of patients. In-hospital mortality was higher among cirrhotic than non-cirrhotic patients (55 versus 7%, p < .001). Patients with bleeding hepatic metastases, but no cirrhosis, had an in-hospital mortality of 0% with no major complications. Patients with benign etiology had a good prognosis and no bleeding- or tumor-related mortality.Discussion: TAE is an effective method in controlling the bleeding in spontaneous hepatic hemorrhage. Underlying pathology determines the prognosis that is poor especially in cirrhotic patients with bleeding hepatocellular carcinoma.

Segment V spontaneous hepatic haemorrhage from hepatic cirrhosis: an emergency abdominal surgery case report

A spontaneous hepatic haemorrhage (SHH) is a rare condition that results from a breach in the hepatic parenchyma that occurs without an external cause. It is an acute surgical emergency as it results in intra-abdominal bleeding that, if untreated, will progress to haemorrhagic shock and death. The clinical presentation is often non-specific but emergent, and rapid diagnosis and treatment is required, often involving a number of services including interventional radiology, hepatology and surgery. SHH is a rare event most commonly caused by HCC and hepatic adenoma although there are numerous other causative lesions including all recognized benign and malignant hepatic tumours including metastatic cancer. The mechanism of spontaneous bleeding remains unclear but there is evidence for compromised vascular integrity at least in patients with HCC and the incidence of the condition in patients with connective tissue diseases. A diagnosis of SHH is based on a clinical index of suspicion in patients with a known underlying condition. However, this is not always as straightforward as SHH is a rare complication in patients with connective tissue disease. Spontaneous hepatic haemorrhage is one of acute abdominal emergency case with high morbidity and mortality rate. Emergency operation plays an important role in managing this case.

A Spontaneously Ruptured Hepatic Metastasis From a Gastric Gastrointestinal Stromal Tumor That Presented as Hemoperitoneum.

Spontaneous hepatic hemorrhage is a rare condition that may be caused by an underlying hepatic tumor, most commonly hepatocellular carcinoma or hepatic adenoma. A spontaneous rupture of a hepatic metastasis from a gastric gastrointestinal stromal tumor is also extremely rare, and the majority of affected patients present with hypovolemic shock or an acute abdomen. In this article, we report the case of a 65-year-old man with a spontaneous rupture of a hepatic metastasis from a gastric gastrointestinal stromal tumor that presented as hypovolemic shock. Cross-sectional imaging studies (computed tomography or magnetic resonance imaging) play a significant role in the diagnosis of this condition and guides its management.

Massive hepatic haemorrhage caused by anabolic steroid-induced peliosis hepatis: Successful treatment by radiofrequency ablation

Peliosis hepatis is an uncommon condition of unknown origin characterized by multiple blood-filled cystic spaces of varying size, focally or diffusely distributed in the liver parenchyma. Spontaneous haemorrhage is a significant complication with a high rate of mortality. We report the case of a massive spontaneous hepatic haemorrhage due to peliosis hepatis in a body builder, who had taken under-the-counter anabolic-androgenic steroids (AAS) for the previous 15 years. Our patient was admitted with a 6-hour history of right upper quadrant abdominal pain. Radiological investigations showed a large haematoma and small hypodense foci in the right lobe of the liver, the largest communicating with the haematoma. By laparotomy, the bleeding peliotic cavity was localized in the posterior aspect of the eighth hepatic segment. The definitive haemostasis was obtained after repeated laparotomy using radiofrequency-induced thermo-coagulation of the peliotic cavity. Histology confirmed the presence of peliosis hepatis. Radiofrequency is a potential treatment for a cataclysmic hepatic haemorrhage in peliosis hepatis. To our knowledge, haemostasis by radiofrequency of a bleeding peliotic lesion has not yet been described.

Spontaneous hepatic hemorrhage secondary to prolonged use of oral contraceptives

Oral contraceptive pills (OCP) are the most commonly used form of contraception throughout the United States of America. The prolonged usage of oral contraceptives leads to a variety of complications, ranging from subclinical modifications of liver function tests to the development of benign and malignant tumors of the liver. Spontaneous hepatic hemorrhage secondary to oral contraceptive use was only reported once in the early 1980s. We report a case of spontaneous hepatic hemorrhage secondary to prolonged ingestion of combined OCPs followed by multiple pulmonary emboli without underlying thrombophilia.

Spontaneous Hepatic Hemorrhage in Older Women

Spontaneous liver hemorrhage in older women is not well described. We report an experience with five postmenopausal women who spontaneously bled from the liver. All five patients presented with acute bleeding. Four were treated nonoperatively. No tumor was identified in any patient. Four patients acutely were discharged alive and well, but one died after operation to control bleeding. Spontaneous liver hemorrhage can occur in a variety of clinical settings, but an association with older women taking hormone replacement and anticoagulation has not been reported.

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Rotura Hepática na Gravidez: Relato de caso

Rotura hepática é uma das mais sérias e catastróficas complicações da gravidez; sua incidência varia de 1:45000 a 1:225000 partos. É usualmente associada a pré-eclâmpsia. A mortalidade materna é de cerca de 60 a 86% e a fetal pode atingir de 56 a 75%. O diagnóstico é difícil, mas freqüentemente confirma-se pela presença de sangramento maciço e choque hipovolêmico. Relatamos o caso de uma paciente na 32ª semana de gravidez complicada por hemorragia hepática espontânea associada a pré-eclâmpsia, que foi submetida a tratamento cirúrgico com bom resultado.

Hepatic haemorrhage during toxaemia and HELLP syndrome

Spontaneous hepatic haemorrhage with subcapsular haematoma formation or subsequent rupture are major complications of toxaemia of pregnancy. A case of severe postpartum hepatic haemorrhage with a leaking sub-capsular haematoma and haemoperitoneum in association with haemolysis, elevated liver enzymes and low platelets (HELLP syndrome) is reported. The patient was treated successfully with blood and plasma transfusion and supportive therapy for acute renal failure. Our case supports the view that patients with hepatic haemorrhage during toxaemia of pregnancy or HELLP syndrome should be treated conservatively and that operative management should be restricted to those patients who are haemo-dynamically unstable.

Spontaneous Hepatic Hemorrhage Associated with Pregnancy

The authors determined the effectiveness of hepatic arterial interruption in treating patients with spontaneous hepatic hemorrhage associated with pregnancy. This rare syndrome frequently is seen with eclampsia/preeclampsia and is associated with high maternal mortality. The recommended treatment has been the use of local hemostatic measures. The authors reviewed their experience managing eight patients by hepatic arterial interruption. Operative hepatic artery ligation was the initial method of controlling hepatic hemorrhage in three patients. One patient recovered, a hepatic sequestrum developed in one, and one patient died. Three patients survived after hepatic arterial embolization, but a sequestrum developed in one. Two patients died when hepatic arterial interruption was used after failed local hemostatic measures. The authors believe that hepatic arterial interruption is the preferred treatment for spontaneous hepatic hemorrhage associated with pregnancy. If the diagnosis is made at the time of cesarean section delivery, operative hepatic arterial ligation is indicated. If the diagnosis is made postpartum, percutaneous angiographic embolization should be performed.

Budd-Chiari Syndrome Complicating Pre-Eclampsia

A 25-year-old primigravida with third-trimester pre-eclampsia developed severe right upper quadrant pain, marked serum aminotransferase elevation, and disseminated intravascular coagulation after cesarean delivery. Computed tomography of the liver showed a right hepatic abnormality that on magnetic resonance imaging had the appearance of hemorrhage; partial thrombosis of the right hepatic vein extending to the inferior vena cava was also seen. Anticoagulation was begun and the patient completely recovered; follow-up imaging 8 months later was normal. This case suggests that nonfatal forms of Budd-Chiari syndrome may complicate pre-eclampsia; predisposition to partial venous outflow obstruction in the pre-eclamptic patient may be pathogenetically related to disseminated intravascular coagulation. This entity may be clinically confused with, or misdiagnosed as, spontaneous hepatic hemorrhage, with or without capsular rupture. In such circumstances, magnetic resonance may be diagnostically useful.

Spontaneous Hepatic Hemorrhage in Preeclampsia: Treatment with Hepatic Arterial Embolization

Four patients with spontaneous rupture of the liver due to preeclampsia of pregnancy underwent diagnostic angiography followed by successful transcatheter embolization of the hepatic artery with gelatin particles. All patients stopped bleeding and were discharged in good condition. Transcatheter embolization of the hepatic artery may be an attractive alternative to surgery for control of spontaneous rupture of the liver in preeclampsia.

Ruptured hepatic artery aneurysms in a patient with systemic lupus erythematosus: Case report

Spontaneous hemorrhage caused by ruptured left hepatic artery branch aneurysms occurred in a 49-year-old man with systemic lupus erythematosus. Following evaluation by computerized tomography and angiography, transcatheter embolization of the left hepatic artery resulted in hemostasis. The various etiologies of hepatic artery aneurysms are discussed. This case demonstrates that systemic lupus erythematosus must be considered in the differential diagnosis of hepatic artery aneurysms and spontaneous hepatic hemorrhage.

Spontaneous hepatic hemorrhage: clinical and CT findings.

The clinical records and radiologic findings in six patients with spontaneous (nontraumatic) intrahepatic and subcapsular hemorrhage were reviewed. Four patients had underlying liver lesions (hepatocellular carcinoma and metastasis from B-cell lymphoma in one patient each and hepatic adenoma in two other patients). One patient had intrahepatic hemorrhage associated with hepatic necrosis secondary to organophosphate toxicity. The specific etiology of hemorrhage in the remaining patient proved elusive despite an exhaustive search. Hepatic hemorrhage was diagnosed and followed by CT (six cases), sonography (two cases), and celiac arteriography (three cases). Computed tomography was useful in defining the extent of the hematoma and showing density changes related to the age of the hematoma.

Spontaneous hepatic hemorrhage during pregnancy

Spontaneous rupture of the liver during pregnancy seems to represent an extreme vascular complication of toxemia. The very high mortality rate has generally been attributable to uncontrolled hemorrhage. However, control of the hemorrhage may not be sufficient to achieve recovery. Hepatic dysfunction may proceed to necrosis associated with multiple organ failure, even after successful hemostasis. Although ligation of the hepatic artery has been successful in controlling hemorrhage in hepatic trauma, this maneuver may contribute to injury in patients with this lesion in whom there is a preexisting hepatic abnormality. In this brief review, the relationship of the underlying pathology to a variety of therapeutic measures in the context of a catastrophic complication of pregnancy are discussed.