Clementi Marco, Colozzi Sara, Guadagni Stefano, Pessia Beatrice, Sista Federico, Schietroma Mario, Della Penna Andrea, Amicucci Gianfranco
Ann Ital Chir. 2017 Jan 20;6:S2239253X17026408.
Spontaneous hepatic rupture without underlying liver diseases is uncommon entity. We report a rare case of spontaneous rupture of liver hematoma in patient treated with warfarin end enoxaparin sodium because of pulmonary embolism. Two day after admission the patient complained generalized abdominal pain and hemodynamic instability. The abdominal US and TC scan revealed free fluid and lesion at right liver lobe. The patient, despite intravenous fluid support and blood transfusion, was hemodinamically instable and urgent laparotomy was needed. At laparotomy, it was found that a subcapsular haematoma, involving the diaphragmatic face of the right liver, had ruptured into peritoneum. Hepatic bleeding was stopped using a conservative approach by Pringle manoeuvre, parenchymal suture and fibrin sealant. There was no complication related to hepatic surgery but the patient died because of new massive pulmonary embolism 10 days after surgery. The absence of underlying liver pathology was confirmed by autopsy examination. This case report suggests that the possibility of spontaneous liver rupture should be considered in patients being treated with oral anticoagulants. Early diagnosis are critically important given the high morbidity and mortality. Aggressive resuscitation and immediate exploratory laparotomy is needed when hemodynamic instability occurs. In our case a quick, safe and effective control of bleeding was provided by partial vascular occlusion, parenchymal suture and topical haemostatic agent.
Anticoagulant therapy, Araumatic hemoperitoneum, Liver hematoma.
无潜在肝脏疾病的自发性肝破裂是一种罕见的情况。我们报告一例罕见的因肺栓塞接受华法林和依诺肝素钠治疗的患者发生肝血肿自发性破裂的病例。入院两天后，患者主诉全腹疼痛和血流动力学不稳定。腹部超声和CT扫描显示右肝叶有游离液体和病变。尽管给予了静脉补液支持和输血，患者血流动力学仍不稳定，需要紧急剖腹手术。剖腹手术时发现，一个累及右肝膈面的包膜下血肿已破裂进入腹膜。通过Pringle手法、实质缝合和纤维蛋白密封剂采用保守方法止住了肝出血。没有与肝脏手术相关的并发症，但患者在术后10天因新的大面积肺栓塞死亡。尸检证实无潜在肝脏病变。本病例报告提示，接受口服抗凝剂治疗的患者应考虑自发性肝破裂的可能性。鉴于高发病率和死亡率，早期诊断至关重要。当发生血流动力学不稳定时，需要积极复苏并立即进行剖腹探查。在我们的病例中，通过部分血管闭塞、实质缝合和局部止血剂实现了快速、安全和有效的出血控制。
抗凝治疗、非创伤性血腹、肝血肿
