Liver hemorrhage due to idiopathic peliosis hepatis successfully treated with hepatic artery embolization

The role of interventional radiology in hepatic and renal hemorrhage embolization: single center experience and literature review

BACKGROUND AND AIM

Intraabdominal hemorrhage secondary to liver and kidney injury is a major cause of morbidity and mortality. Endovascular arterial embolization is an established interventional radiology technique used to treat active bleeding, and its role in managing abdominal hemorrhages is growing, given the increasing trend for conservative treatment. Our study aims to retrospectively evaluate the technical and clinical results and the possible complications of arterial embolization procedures performed in emergency, in post-traumatic, iatrogenic, and pathological hepatic and renal bleedings.

METHODS

We performed a ten-year, single-center retrospective survey (from January 2010 to December 2019) of all patients treated in emergency by intra-arterial embolization of liver and kidney bleeding. Preliminary CT angiography studies were evaluated, as well as the angiographic findings. Materials used, procedural data, and clinical outcomes, including complications, were recorded.

RESULTS

The diagnostic angiography showed a single source of bleeding in 20 cases (66.7%), two bleeding vessels in 4 cases (13.3%), and multiple hemorrhagic sources in 6 cases (20%). All bleeding sources were successfully embolized; in 12 patients (40%), complete embolization was achieved with coils and 18 patients (60%) with hemostatic sponges. In one case, a second embolization procedure was performed for the persistence of hemodynamic instability. No major post-procedural complications were recorded. The mean procedure duration was 65.1 minutes.

CONCLUSIONS

Based on our experience and literature data, the treatment of endovascular embolization in acute abdominal bleeding of hepatic and renal origin represents the treatment of choice, as it can provide complete therapeutic success in hemodynamically stable patients. (www.actabiomedica.it).

Spontaneous rupture of the liver in a patient admitted for subarachnoid hemorrhage

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Spontaneous rupture of the liver is a rare event often associated with the presence of malignant liver disease or occurring in the context of a HELLP syndrome.

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The treatment of hemorrhage due to spontaneous rupture of the liver includes, in addition to serial monitoring of hemoglobin values, in cases of unstable patients, embolization, hepatic resection and packing.

INTRODUCTION

Spontaneous rupture of the liver is a rare event often associated with the presence of malignant liver disease or occurring in the context of a HELLP syndrome.

We present a case of spontaneous rupture of the liver in a patient admitted to our Intensive Care Department with hemoperitoneum in the aftermath of recent surgical clipping of a cerebral aneurysm.

PRESENTATION OF CASE

We report a 50-year-old woman who was transferred from the Bolzano Hospital Department of Neurosurgery to the Intensive Care Unit with anemia and the occurrence of major abdominal pain.

DISCUSSION

Spontaneous hepatic rupture remains a rare event, associated more often than not with pregnancy or traumatic events. The treatment of hemorrhage due to spontaneous rupture of the liver includes, in addition to serial monitoring of hemoglobin values, in cases of unstable patients, embolization, hepatic resection and packing.

CONCLUSION

The case described here shows that spontaneous rupture of the liver may be due to indefinable causes and that its treatment remains complex and multidisciplinary.

Spontaneous hepatic rupture in a patient with peliosis hepatis: A report of one case

INTRODUCTION

Liver rupture is a serious event that is most commonly due to blunt abdominal trauma. We present a case of peliosis hepatis in a patient admitted for acute pyelonephritis who developed hemoperitoneum due to spontaneous hepatic rupture from this rare liver condition.

PRESENTATION OF CASE

We report a 44 year-old woman who presented to our hospital with acute pyelonephrititis and hemoperitoneum due to spontaneous hepatic rupture from peliosis hepatis. Physicians should be aware of this rare condition in patients who present with non-traumatic hepatic rupture with hemoperitoneum.

DISCUSSION

PH should be considered in all patients with known risk factors who present with typical morphological changes or a hepatic mass, especially when the cause of sudden intraperitoneal hemorrhage is obscure.

CONCLUSION

Peliosis hepatis is most often asymptomatic and an incidental finding at autopsy. In symptomatic patients, surgery should be reserved for those patients whose hemorrhage is-life-threatening. Familiarity with the imaging characteristics can help in earlier diagnosis of peliosis hepatis.