Intrahepatic pseudoaneurysm after surgical hemostasis for a delayed hemorrhage due to blunt liver injury: report of a case

Life-saving intervention following spontaneous rupture of splenic vein in a young patient: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

The spontaneous rupture of the splenic vein is indeed a rare occurrence, and it carries a high risk of mortality. To date, only a very limited number of documented cases of splenic vein rupture attributed to hepatic cirrhosis have been reported.

CASE PRESENTATION

A 17-year-old male patient was urgently referred to our hospital due to sudden severe abdominal pain. Upon admission, the patient displayed critical signs, including abdominal tenderness and shock. Lab results revealed low red blood cell count and elevated creatinine levels. A CT scan uncovered a substantial abdominal fluid accumulation and a ruptured splenic vein alongside a dilated superior mesenteric vein. Emergency exploratory surgery revealed extensive intraperitoneal bleeding due to the splenic vein rupture, leading to a total splenectomy and vein ligation. Surprisingly, histological findings confirmed liver cirrhosis, although the patient had shown no liver-related symptoms prior to surgery. Over six months of careful monitoring, the patient displayed significant improvement in health with no complications or readmissions.

CLINICAL DISCUSSION

The rupture of the splenic vein is an uncommon condition that should be taken into consideration when evaluating the potential causes of intra-abdominal hemorrhage, particularly in cirrhotic patients and pregnant women. The appropriate treatment typically involves controlling the hemorrhage and performing the ligation of the splenic vein, often necessitating an urgent splenectomy.

CONCLUSION

This case underscores the critical importance of considering uncommon sources of sudden intraperitoneal hemorrhage, such as splenic vein rupture. It also emphasizes the vital role of prompt surgical intervention in such cases.

A rare presentation of spontaneous rupture of splenic vein aneurysm as cardiac arrest: A case report

Splenic vein aneurysm (SVA) is a rare condition associated primarily with portal hypertension. This case highlights a potentially fatal, rare SVA complication in a young patient who presented in cardiac arrest, creating a diagnostic enigma in the emergency department until a POCUS revealed a possible underlying etiology.

Hepatic trauma: contemporary management

In the introduction, I posed several questions that were issues/controversies. The answers will probably be interpreted as equally controversial. I do not believe there is strong evidence that the incidence of liver injuries has increased. Diagnostic modalities have contributed to this seeming increase, as well as population increases and the concentration of severe liver injuries in trauma centers, now present in 35 states. I believe there are more blunt injuries now, relative to penetrating injuries. The peak of penetrating injuries occurred in the 1970s and 1980s and lasted almost 2 decades. I believe some authors are overly enthusiastic for nonoperative management. I am particularly critical of authors who do not include all components of the surgical armamentarium into their treatment of severe liver injuries. I also believe that the complications following nonoperative management are currently unacceptable, as documented in the references. I have shared with you the strategies for operative management, but there are equally good or better strategies in the surgical literature.

Role of postoperative computed tomography in patients with severe liver injury

BACKGROUND

The role of postoperative computed tomography (CT) in asymptomatic patients with severe liver injury has not been investigated. The aim of the present study was to investigate the nature and incidence of significant liver-related abnormalities detected by postoperative CT in asymptomatic patients with severe liver injury.

METHODS

This was a prospective study of survivors with severe liver injury (grades III-V) who were treated surgically. The patients underwent CT to evaluate the liver after operation, irrespective of symptoms.

RESULTS

During the study interval there were 181 patients with severe liver injury, of whom 49 fulfilled the criteria for inclusion. The overall incidence of liver-related complications detected by CT was 49 per cent (necrotic areas in the liver in seven patients, seven bilomas, four abscesses, three perihepatic collections and three false aneurysms). In the subgroup of 17 asymptomatic patients CT revealed four abnormalities: two large bilomas, one false aneurysm and one fluid collection. Two of these patients required therapeutic intervention and the other two remained under observation.

CONCLUSION

In view of the incidence of asymptomatic significant liver abnormalities following operative management of severe liver injury, it is recommended that these patients undergo routine postoperative CT.