[Spontaneous, massive liver hemorrhage as a complication of thrombolysis with ultra-high dose streptokinase in deep thrombophlebitis].

We report on a rare case of spontaneous, life-threatening liver bleeding as a major complication of thrombolysis using short-term, ultrahigh streptokinase in deep venous thrombosis. The event occurred in a female patient (age 40 years) who presented no contraindication to thrombolytic therapy. Intraabdominal bleeding was suspected during intravenous streptokinase infusion. Emergency laparotomy revealed four liter of unclotted blood resulting from two ruptured subcapsular liver haematomas. Local haemostasis was achieved and the integrity of the liver restored. Multiple transfusions of red blood cells, fresh frozen plasma and fibrinogen were given. The postoperative period was uneventful and the patient recovered gradually. The patient could be discharged from the hospital in good health. Diagnostic and therapeutic approaches to this rare complication of thrombolysis are discussed. Additionally, a brief review of previously reported cases is provided.