Zhou Jin-Bao, Chen Wei-Bo, Zhu Feng
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, China.
Case Rep Surg. 2018 Jan 28;2018:2026846. doi: 10.1155/2018/2026846. eCollection 2018.
The etiology of hepatic rupture is usually secondary to trauma, and hepatic rupture induced by spontaneous intrahepatic hematoma is clinically rare. We describe here a 61-year-old female patient who was transferred to our hospital with hepatic rupture induced by spontaneous intrahepatic hematoma. The patient had no history of trauma and had a history of systemic lupus erythematosus for five years, taking a daily dose of 5 mg prednisone for treatment. The patients experienced durative blunt acute right upper abdominal pain one day after satiation, which aggravated in two hours, accompanied by dizziness and sweating. Preoperative diagnosis was rupture of the liver mass. Laparotomy revealed 2500 mL fluid consisting of a mixture of blood and clot in the peritoneal cavity. A 3.5 cm × 2.5 cm rupture was discovered on the hepatic caudate lobe near the vena cava with active arterial bleeding, and a 5 × 6 cm hematoma was reached on the right posterior lobe of the liver. Abdominal computed tomography (CT) and laparotomy revealed spontaneous rupture of intrahepatic hematoma with hemorrhagic shock. The patient was successfully managed by suturing the rupture of the hepatic caudate lobe and clearing part of the hematoma. The postoperative course was uneventful, and the patient was discharged after two weeks of hospitalization.
肝破裂的病因通常继发于外伤，而自发性肝内血肿所致的肝破裂在临床上较为罕见。我们在此描述一位61岁的女性患者，她因自发性肝内血肿导致肝破裂而被转至我院。该患者无外伤史，有系统性红斑狼疮病史5年，每日服用5毫克泼尼松进行治疗。患者在饱餐后一天出现持续性右上腹钝痛，两小时后加重，伴有头晕和出汗。术前诊断为肝脏肿物破裂。剖腹探查发现腹腔内有2500毫升由血液和血凝块混合而成的液体。在靠近腔静脉的肝尾状叶发现一个3.5厘米×2.5厘米的破裂口，有活动性动脉出血，在肝右后叶发现一个5×6厘米的血肿。腹部计算机断层扫描（CT）和剖腹探查显示为自发性肝内血肿破裂并伴有失血性休克。通过缝合肝尾状叶破裂口并清除部分血肿，患者成功得到救治。术后病程顺利，患者住院两周后出院。
