Multiple liver perforations: complication of an outpatient liposuction procedure

Iatrogenic Liver Perforation During Liposuction: A Case Report and In-depth Review of Clinical Presentation, Management, and Lessons Learned

Liposuction is generally recognized as a safe medical procedure. However, it is important to acknowledge the potential for complications during and after the operation. Although rare, the occurrence of iatrogenic liver perforation following liposuction is viewed as a serious complication, necessitating immediate and attentive medical care. We report a case of a 42-year-old female who underwent liposuction and presented with abdominal pain 3 days later. Elevated liver enzymes and imaging revealed an active bile leak from the right liver lobe. Exploratory laparotomy confirmed a penetrating injury, leading to multiple washout surgeries. After a 3-month hospital stay, including intensive care, the patient fully recovered upon discharge following abdominal wound closure. Despite considering liposuction procedures safe due to the associated overall low risk rates, it can lead to life-threatening complications such as hollow viscus or solid organ injury. The treatment for such complications can either be surgical or nonsurgical, depending on the patient's presentation and diagnosis. To promptly identify and address any complication postsurgery, close monitoring of patients postoperatively is necessary.

Level of Evidence 5

Abdominal Visceral Injury, a Devastating Consequence of Abdominal Liposuction: A Case Report and Literature Review

Abdominal liposuction is a commonly performed cosmetic procedure. However, as with any procedure, it can be associated with complications. One of the life-threatening complications of this procedure is visceral injury and bowel perforation. This complication is very rare, nevertheless general, and acute care surgeons must be aware of its possibility, its management, and its possible sequelae. We report a case of a 37-year-old female who underwent abdominal liposuction which was complicated by bowel perforation and was transferred to our facility for further care. She underwent an exploratory laparotomy in which multiple perforations were repaired. The patient then underwent multiple surgeries including stoma creation and had a long postoperative course. A literature review reveals the devastating sequelae of reported similar visceral and bowel injuries. The patient eventually did well and her stoma was reversed. This patient population will require close intensive care unit observation and a low threshold of suspicion for missed injuries during initial exploration. Further down the line, they will need psychosocial support and the mental health implications of this outcome must be cared for. The long-term aesthetic outcome is yet to be addressed.

Perforation of Abdominal Viscera Following Liposuction: A Systemic Literature Review

BACKGROUND

Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a rare complication of the procedure, visceral perforation is associated with morbidity and severe debilitation.

METHODS

The authors conducted a literature search for reported cases of perforation of abdominal viscera following liposuction procedures in the electronic databases of PubMed, Scopus and Cochrane Library databases.

RESULTS

The authors found 22 publications; 19 cases case reports and three studies, reporting a total of 49 cases of visceral perforation following abdominal liposuction procedures. Average age of patients was 50 years (range 24-72). Twenty-seven patients (73%) were female, and 10 were male (27%). Forty (81%) patients underwent isolated liposuction, and nine (19%) had multiple procedures carried out in a single surgery. Twenty patients (42%) had undergone previous abdominal surgery, 13 (27%) suffered abdominal wall weakness or deformities, and 7 (14%) suffered from obesity. 25 (52%) ileal perforations occurred, 6 jejunal (12.5%), 5 colic (10%) and 2 (4%) each of splenic and hepatic. Seven patients (14%) died during their hospitalization, 20 (41%) were discharged with no sequelae complications, and 22 (45%) developed complications after discharge.

CONCLUSIONS

Liposuction is a popular esthetic procedure that underwent numerous changes over the past century since its introduction. Despite its widely accepted reputation of a safe procedure with minimal complications, a growing number of reports on visceral perforation following liposuction have emerged. Scrupulous pre-operative evaluation and high index of suspicion are crucial for avoiding complications and unfavorable outcomes.

LEVEL OF EVIDENCE III

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