Damiani Gianluca Raffaello, Merola Viviana, Barnaba Mario, Landi Stefano, Cormio Gennaro, Pellegrino Antonio
Department of Obstetrics and Gynecology, Alessandro Manzoni Hospital, Dell'Eremo Street 11, 23900 Lecco, Italy.
Department of Obstetrics and Gynecology, University of Bari, 70124 Bari, Italy.
Case Rep Med. 2014;2014:312938. doi: 10.1155/2014/312938. Epub 2014 Aug 31.
A careful management of hepatic capsular rupture, with massive hemoperitoneum which occurred 14 hours after an emergency cesarean section at 36 weeks of gestation, is meticulously reported. The grade of hepatic involvement varies from minor capsular laceration to extensive parenchymal rupture. Our management involved a combination of surgical interventions and aggressive supportive care. The patient was discharged after 53 days and 4 laparotomies and an unsuccessful attempt of superselective artery embolization. Ultrasound after 40 days from the last surgery showed uniform hepatic parenchyma free of focal lesions. Due to the rarity and the unpredictability nature of this devastating event we believe necessary to report our experience, reinforcing the importance of the postsurgery management.
详细报告了对一例肝包膜破裂的精心处理，该病例发生在妊娠36周紧急剖宫产术后14小时，伴有大量腹腔积血。肝脏受累程度从轻微的包膜撕裂到广泛的实质破裂不等。我们的处理方法包括手术干预和积极的支持治疗相结合。患者在经历53天、4次剖腹手术以及一次超选择性动脉栓塞术未成功后出院。最后一次手术后40天的超声检查显示肝脏实质均匀，无局灶性病变。由于这一灾难性事件的罕见性和不可预测性，我们认为有必要报告我们的经验，强调术后管理的重要性。
