Search

Background: Spontaneous hepatic rupture associated with the syndrome characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome) is a rare and life-threatening condition, and only a few cases regarding the management of this condition through transcatheter arterial embolization (TAE) have been previously reported. Case summary: Herein, we report a case involving a 35-year-old pregnant woman who presented at 28 weeks of gestation with right upper quadrant pain, hypotension, and elevated levels of liver enzymes. Transabdominal ultrasound revealed fetal death. She required an emergency cesarean section, and hepatic rupture was identified after the fetus had been delivered. Hepatic packing and TAE were performed. The postprocedural course was uneventful, and the patient was discharged 14 days after she had been admitted to our hospital. Conclusions: Spontaneous hepatic rupture associated with HELLP syndrome is a very serious condition that requires prompt and decisive management. The high maternal and fetal mortality rates associated with this condition can be reduced through early accurate diagnosis and adequate management. The findings in the reported case indicate that TAE may be an attractive alternative to surgery for the management of spontaneous hepatic rupture associated with HELLP syndrome.

IntroductionThe management of a patient suffering from blunt abdominal trauma (BAT) remains a challenge for the emergency physician. Within the last few years, the standard therapy for hemodynamically stable patients with BAT has transitioned to a non-operative approach. The purpose of this study is to evaluate the outcome of patients with BAT and to determine the reasons for failure of non-operative management (NOM).Materials and methodsAnalysis of 176 consecutive patients treated for BAT was conducted in a German level 1 trauma center from 2004 to 2011. Abdominal injuries were classified according to the American Association for the Surgery of Trauma (AAST). Patients included were demonstrated to have objective abdominal trauma with either free fluid on focused assessment with sonography for trauma (FAST) or computed tomography (CT), or proven organ injury.ResultsPatients, 142 of 176 (80.7%), with BAT were initially managed non-operatively, with a success rate of 90%. The rates of NOM success were higher among those with less severe injuries; 100% with Abbreviated Injury Scale (AIS) of 1. In total, 125 patients (71.0%) were managed non-operatively, and 51 (29.0%) required surgical intervention. NOM failure occurred in 9.2% of the patients, the most common reason being initially undiagnosed intestinal perforation (46.2%). Positive correlation was identified (r = 0.512; p ConclusionNOM was successful for the vast majority of blunt abdominal trauma patients, especially those with less severe injuries. NOM failure and operative delay were most commonly due to occult hollow viscus injury (HVI), the detection of which was achieved by close clinical observation and abdominal ultrasound in conjunction with monitoring for rising markers of infection and by multidetector computed tomography (MDCT) if additionally indicated. Based on this concept, the delay in operation in patients with NOM failure was short. This study underscores the feasibility and benefit of NOM in BAT.

The hepatic rupture durig pregnancy is a catastrophic clinical issue associated with high fetal and maternal mortality. We describe the case of hepatic hemangioma rupture complicated by massive thrombosis of the inferior vena cava successfully treated by using AngioVac aspiration system. Although an aggressive surgical strategy is recommended, a multidisciplinary approach using modern devices can represent a new frontier in the treatment of these patients.

One of the pathologies that most frequently cause serious complications, including maternal and perinatal death, is preeclampsia. Among its complications are the development of hemolysis, elevated liver enzymes, and thrombocytopenia (HELLP syndrome), which includes a triad formed by a hepatorenal scenario and the development of thrombocytopenia.

We report the case of a 34-year-old woman with a 32-week pregnancy complicated by recurrent severe preeclampsia, HELLP Class I syndrome, and an intact hepatic hematoma of the right lobe detected by ultrasound. During the cesarean section, the rupture of the hematoma occurred and a gastroesophageal probe of the Sengstaken-Blakemore type was placed to occlude the bleeding cavity and the exit tunnel. The balloons were deflated gradually and the probe was removed on the 10th day without complications. The Sengstaken-Blakemore probe can be an effective remedy to control liver bleeding in selected cases.

Pneumobilia is the presence of air in the biliary system. It mostly indicates a connection between the biliary system and the gastrointestinal tract, although it can also occur after trauma. The best diagnostic modality of pneumobilia is computed tomography (CT). We herein present a 32-year-old male patient with pneumobilia due to hepatic rupture caused by abdominal trauma after car crash. The instability of the patient and hepatic rupture were the reasons of surgical treatment. The surgeon should know that pneumobilia and portal venous gas are easily confused. While mortality risk of pneumobilia is lower than that of portal venous gas, in such conditions the patient should be operated, because chance of cure is quite high., Pnömobili, biliyer sistemde hava varlığıdır. Çoğunlukla biliyer sistem ile gastrointestinal sistem arasındaki bağlantıyı gösterir, ancak travmadan sonra da ortaya çıkabilir. En iyi tanısal radyolojik tetkik, bilgisayarlı tomografidir (BT). Bu yazıda, trafik kazası dolayısıyla gelişen karın travmasının neden olduğu hepatik rüptüre bağlı pnömobili ile prezente olan, 32 yaşında bir erkek hasta sunulmaktadır. Hastanın cerrahi endikasyonları, instabilitesi ve hepatik rüptürdü. Cerrahlar pnömobili ve portal venöz gazın kolayca karıştığını bilmelidirler. Pnömobilinin mortalite riski portal venöz gazınkinden daha düşük olmakla birlikte, bu gibi durumlarda hasta kesinlikle ameliyat edilmelidir, çünkü iyileşme şansı oldukça yüksektir.

Hepatic rupture is a rare complication of pregnancy associated with preeclampsia and HELLP syndrome, thus increasing maternal morbidity and mortality. There are no reported cases of this condition in high-altitude dweller pregnant women, even though altitude is considered a factor that influences in pregnancy. In this article the case of a pregnant dweller at high altitude is reported, which revealed hepatic rupture with persistent bleeding, being reoperated by Emergency Surgery appropriately thanks to the hemodynamic monitoring with transesophageal Doppler. La rotura hepática es una complicación poco frecuente de la gestación que se asocia a preeclampsia y síndrome HELLP, aumentando la morbimortalidad materna. No hay reportados casos de esta patología en gestantes residentes en altura, a pesar de que se considera a la altura como un factor que influye en la gestación. En este artículo se reporta el caso de una gestante residente de la gran altura, la cual evidenció una rotura hepática con sangrado persistente, siendo reintervenida por cirugía de emergencia oportunamente gracias al monitoreo hemodinámico con doppler transesofágico.

The objective of index study is to review the available literature on hepatic rupture or hematoma in hypertensive disorders of pregnancy to find the incidence, associated risk factors, clinical presentation, mode of management and feto-maternal outcome. Electronic database was searched using hepatic rupture or hematoma in pregnancy, preeclampsia, eclampsia, and HELLP syndrome (Hemolysis, EL: elevated liver enzymes, LP: low platelet count) as key words and literature published since January, 2000 to December, 2018 which met the inclusion criteria was reviewed. A total of 56 articles were reviewed describing 93 cases of hepatic hemorrhage in hypertensive disorders of pregnancy. Treatment varied from conservative management to abdominal packing, hepatic artery embolization, and partial hepatectomy to liver transplantation. Seven out of 93 patients with liver rupture met mortality and in one of them diagnosis was established on autopsy. Unawareness of the hepatic rupture in pregnancy by an obstetrician demands high index of suspicion for diagnosis and requires specialized, focused and exhaustive management for optimal feto-maternal outcome. Laparotomy and perihepatic packing is a viable option in patients with unstable vitals and is feasible even in limited resource settings.Short interval between diagnosis and management may enhance the feto-maternal survival rate and prevent further morbidity or mortality.

Background Spontaneous hepatic rupture in pregnancy is a rare and life-threatening event during the perinatal period. Case presentation We report a case of a 33-year-old woman with 36 + 6 weeks’ gestation that present with elevated blood pressure before delivery, who was admitted to our hospital due to irregular abdominal pain. Diagnosed with abdominal paracentesis, the emergent caesarean section and laparotomy were performed. Postoperatively, the patient experienced 22-day intensive therapy in ICU and was transferred to the General Surgery Department in good physical condition without post-operative complications. Conclusions This case indicates that making an accurate and timely diagnosis and taking multidisciplinary approach contribute to a successful clinical outcome.

Hepatic rupture is a complication during pregnancy that, although rare, accounts for high morbidity and mortality rates. It is mainly associated with severe preeclampsia and HELLP syndrome. Incidence is estimated to be at one per 67,000 births or one per 2000 patients with preeclampsia/eclampsia/HELLP, mainly in multiparous women; women in their 40s; after 32 weeks of gestation; and during the first 15 h postpartum.This article exposes the institutional experience at Fundación Valle del Lili in Cali, Colombia, in managing and treating hepatic rupture associated with severe preeclampsia and HELLP syndrome in three patients in the 30th, the 26th, and the 27th week of gestation, not resulting in maternal death.A search in Pubmed, Embase, and Ovid from 2000 to 2017 resulted in 35 cases reported in either pregnant or puerperal women. Hepatic rupture is a rare complication in pregnancy associated with preeclampsia and HELLP syndrome. Its pathophysiology is attributed to the presence of vasospasm due to an increase in concentration and sensitivity to circulating vasopressors during pregnancy. There is no standard management, but surgery reduces mortality significantly. It includes endovascular management, partial hepatectomy, or transplant (only one patient required a liver transplant in our search). The most used techniques have been ligation of the hepatic artery, embolization of the hepatic artery, and examination, packing, and drainage of hepatic lesion for bleeding control (27 cases were treated with laparotomy with evacuation of hematoma and hemostasis and four cases were treated with embolization of the hepatic artery). Hepatic artery occlusion both by surgery ligation and by embolization through interventional radiology has reported successful and failing results during pregnancy Conclusion: Management of pathologies as hepatic rupture associated with severe preeclampsia and HELLP syndrome has to be clearly protocolized for prompt diagnosis and early management. Furthermore, it has to be carried out through multidisciplinary teams in high-complexity obstetrics scenarios.

Objetivo. Determinar las características clínicas y manejo de casos de hematoma hepático subcapsular (HHS), como consecuencia de preeclampsia y síndrome HELLP durante los años 2004 al 2016. Diseño. Estudio descriptivo, retrospectivo, tipo serie de casos. Lugar. Instituto Nacional Materno Perinatal, Lima, Perú. Material. Historias clínicas de pacientes con HHS. Métodos. Se revisó los casos de HHS atendidos durante los años 2004 al 2016, identificados en forma retrospectiva. Con fines de comparación, se identificó también los casos de la literatura mundial en PubMed. Principales medidas de resultados. Incidencia, características clínicas, manejo y evolución. Resultados. Se encontró 31 casos de HHS, con incidencia de 1 en 6 000 a 9 000 partos. La edad promedio fue 34 años y 81 % multíparas. La forma de diagnóstico más frecuente fue la visión directa durante la cesárea (45%). El síntoma más frecuente fue dolor en abdomen superior (52%), cefalea (36%), estado de conciencia alterado (31 %) Y hematuria (48%). En 90% se practicó empaquetamiento hepático y en 10% observación y monitoreo. En 44% se colocó Bolsa de Bogotá en la primera intervención quirúrgica y en los últimos 2 años se utiliza el sistema VAC para evitar el síndrome comparta mental. El 74% de los casos sobrevivió y 26% falleció. El promedio de estancia hospitalaria fue de 23,2 días. Conclusiones. La incidencia de hematoma hepático subcapsular como consecuencia de preeclampsia y síndrome HELLP fue 1 en 6 000 a 9 000 partos. La hematuria fue un signo relevante y debiera ser motivo de estudio posterior. El 90% de empaquetamiento hepático tuvo diferencias estadísticas con lo reportado en la literatura mundial (p = 0,0025), debido probablemente a la tendencia en procedimientos conservadores. A pesar de solo usar manejo quirúrgico, la cifra de mortalidad fue similar a la reportada en la literatura mundial (26% versus 17%; p = 0,2702). Objective: To determine the clinical characteristics and management of subcapsular hepatic hematoma (SHH) as a result of severe preeclampsia and HELLP syndrome in the period 2004-2016. Design: Descriptive, retrospective study, series of cases type. Setting: Instituto Nacional Materno Perinatal, Lima, Peru. Material: We reviewed the clinical charts of patients with SHH. Methods: The clinical charts of cases with SHH attended at our institution between 2004 and 2016 were reviewed. Search also included PubMed and the results were compared with those in the literature. Main outcome measures: Incidence, clinical features, diagnosis, management and results. Results: 31 cases of SHH were found, with an incidence of 1 in 6 000 to 9 000 births. The mean maternal age was 34 years and 80% were multiparous. Diagnosis was usually through direct visualization of the hepatic rupture during caesarean section (45%). The most frequent symptoms were upper abdominal pain (52%), headache (36%), alteration of consciousness (31 %) and hematuria (48%). Liver packing was performed in 90% of the cases; observation and monitoring, in 10%. In 44% of cases, a Bogotá bag was placed during the first surgery. During the last 2 years, we have recurred to vacuum-assisted closure to prevent compartment syndrome. 74% of cases survived and 26% died. The average hospital stay was 23.2 days. Conclusions: The incidence of subcapsular hepatic hematoma as a result of severe preeclampsia and HELLP syndrome was 1 in 6 000 to 9 000 births. Hematuria was a significant sign and should be studied further. Liver packing was performed in 90% of patients, a statistically significant higher rate than that reported in the literature (p=0.0025), maybe due to a preference for conservative management. Despite only performing surgical treatment, the mortality rate was similar to that reported in the literature (26% versus 17%; p=0.2702).

Spontaneous hepatic rupture is an uncommon cause of haemorrhagic shock and very rarely happens due to amyloidosis. This report describes one such case in which a middle-aged man presented in extremis. He was managed initially with massive transfusion, interventional radiology embolisation and decompressive laparotomy for abdominal compartment syndrome. Subsequent coagulopathy was treated with activated factor VII due to deficient native activity. Serum protein electrophoresis and liver biopsy during his hospital course yielded a diagnosis of amyloidosis, which was treated palliatively with steroids and bortezomib. Despite supportive care, he died 10 days after presentation. This case illustrates the importance of considering an uncommon pathology when a patient presents with a condition in an uncommon way.

Introduction: Spontaneous hepatic rupture is one of the most feared complications of pregnancy that leads to maternal near miss and death and is mainly associated with severe preeclampsia. Objective: To determine risk factors for spontaneous hepatic rupture in pregnant women with severe preeclampsia. Methods: We performed a cross-sectional, retrospective case-control study during the period January 1, 2006 through December 31, 2018. Thirty-one women with severe preeclampsia who presented hepatic rupture (cases) were compared to sixty-two controls (women with severe preeclampsia without hepatic rupture), in a ratio of two controls per case. Results: Factors significantly associated with hepatic rupture in women with severe preeclampsia were HELLP syndrome (OR = 3.42, 95% CI: 1.51 to 6.17), advanced maternal age (OR = 2.18; 95% CI: 1.13 to 5.02) and eclampsia (OR = 1.94, 95% CI: 1.09 to 4.38). Conclusions: In this study of pregnant women with severe preeclampsia, advanced maternal age was a risk factor for spontaneous hepatic rupture, and HELLP syndrome and eclampsia were associated factors. Introducción. La rotura hepática espontánea es una de las complicaciones más temidas del embarazo, que causa morbilidad materna extrema y muerte y se asocia principalmente con la preeclampsia severa. Objetivo. Determinar los factores de riesgo para rotura hepática espontánea en gestantes con preeclampsia severa. Método. Se realizó un estudio retrospectivo transversal, observacional analítico, de tipo casos y controles, durante el período comprendido entre el 1º de enero de 2006 y el 31 de diciembre de 2018. Treinta y una mujeres con preeclampsia severa que presentaron rotura hepática (casos) fueron comparadas con un grupo de sesenta y dos controles (mujeres con preeclampsia severa que no presentaron rotura hepática), correspondiendo dos controles por caso. Resultados. Los factores estadísticamente significativos para rotura hepática en mujeres con preeclampsia severa fueron el síndrome HELLP (OR = 3,52; IC 95%: 1,58 a 6,39), la eclampsia (OR = 2,23; IC 95%: 1,16 a 5,11) y la edad materna avanzada (OR = 1,96; IC 95%: 1,09 a 4,38) tuvieron asociación estadísticamente significativa para rotura hepática espontánea. Conclusiones. En el presente estudio de gestantes con preeclampsia severa, la edad materna avanzada constituyó factor de riesgo para la rotura hepática espontánea, y el síndrome HELLP y la eclampsia fueron factores asociados.

HELLP syndrome is a rare complication of pregnancy that may result in serious consequences such as hepatic rupture, one of the most feared and potentially life-threatening complications. This article aims to carry out a literature review on hepatic rupture in the context of HELLP syndrome as well as to present two clinical cases.

Introduction. Management of a polytraumatized patient is a problem that requires a multidisciplinary approach, in order to optimise patient’s outcome. The purpose of this study is to show the approach in the treatment of a patient with a severe life-threatening polytrauma, including a personalized healthcare approach, after the inadequate initial treatment with the positive outcome. Case report. We present a case of a young polytraumatized patient with trauma as a result of road traffic accident. The patient had chest injuries, abdominal injuries and right arm injuries. He was diagnosed of hepatic rupture with conquasation and retroperitoneal hematoma and the patient underwent liver tamponade. Chest trauma was treated by chest drainage. After the adequate multidisciplinary interventions for the patient, the patient was discharged. Conclusion. This case report is of great importance since it shows that severe polytraumatized patients with bad initial prognosis can successfully receive a life - saving treatment.

Summary: A 34-year-old normotensive nulliparous woman at 38 weeks’ gestation developed sudden onset of severe right upper quadrant pain, fetal distress, hypotension, and a generalised seizure. At urgent Caesarean section, a ruptured subcapsular liver haematoma was found. A healthy infant was delivered. Haemostasis was obtained with a Pringle manoeuver and liver packing. Subsequent bloodwork diagnosed HELLP syndrome. Both the patient and the infant made a full recovery. This case demonstrates the effectiveness of prompt application of these surgical manoeuvres.

CERVOXY ACL CLIN; International audience; HELLP syndrome, which consists of hemolysis, elevated liver enzymes, and low platelet count is an unusual complication of pregnancy that is observed in only 10% to 15% of women with preeclampsia. Hepatic involvement in HELLP syndrome may present with various imaging features depending on the specific condition that includes nonspecific abnormalities such as perihepatic free fluid, hepatic steatosis, liver enlargement, and periportal halo that may precede more severe conditions such as hepatic hematoma and hepatic rupture with hemoperitoneum. Maternal clinical symptoms may be nonspecific and easily mistaken for a variety of other conditions that should be recognized. Because hepatic hematoma occurring in association with preeclampsia and HELLP syndrome is a potentially life-threatening complication, prompt depiction is critical and may help reduce morbidity and mortality. This review provides an update on demographics, risk factors, pathophysiology, and clinical features of hepatic complications due to HELLP syndrome along with a special emphasis on the imaging features of these uncommon conditions.

Se presenta un trabajo retrospectivo de 31 pacientes eclámpticas, que da una incidencia de 2 .6 eclámpticas por 1,000 partos, de ellos 4 pacientes fallecieron dando una tasa de mortalidad materna específica de 1,600 por 10,000 nacidos vivos. El 96.8% fueron pacientes sin control prenatal. La variedad ante-parto fue más frecuente con una incidencia de 83.9 %. La mortalidad materna fue mayor en pacientes con más de 30 años (37%) todas las madres que murieron tuvieron partos espontáneos, las causas de muerte fueron insuficiencia renal (dos casos) edema cerebral y ruptura hepática (un caso cado uno).

Se presenta un caso de ruptura hepática, en una primigesta de 31 años, quien presentó parto por cesárea por óbito fetal y luego falleció, a pesar de las medidas terapéuticas instauradas. Se hace una revisión de los conocimientos actuales sobre esta complicación del síndrome HELLP.

Introduction: We report the case of a patient with antepartum HELLP syndrome and simultaneous rupture of the right liver lobe. An emergency caesarean section was performed and the liver rupture was managed surgically via perihepatic packing. The mother and her child recovered well and were discharged 19 days after admission. Case Report: We describe a case report and review the literature. Based on our own experience and the most common clinical presentations of such patients, we were able to establish an algorithm for managing such cases. Conclusion: An association between liver rupture and HELLP syndrome is rare but was previously described in several case reports. In pregnant women with HELLP syndrome and acute onset abdominal pain, a potential spontaneous hepatic rupture should be taken into consideration.

This article is the first description of a spontaneous hepatic rupture in a young bodybuilder with a history of clenbuterol and ephedrine alkaloid use. The patient presented with a sudden mid-epigastric pain and vomiting. Hemoglobin levels decreased a few hours later and a computed tomography scan was performed which revealed a rupture of the right liver capsule and hemoperitoneum. Two attempts at transarterial embolization did not control the bleeding and a right hemihepatectomy was performed. The pathological report identified a hepatic adenoma, a capsular tear and diffuse peliosis hepatis. The patient was discharged in a good condition after eleven days. Spontaneous hepatic ruptures are rare and life-threatening and are usually described in association with tumors, connective tissue diseases and gestosis. This article is a review of the available literature with regard to this condition, with a focus on its relation to peliosis hepatis and banned substance used by body image fanatics. The present case highlights the challenging diagnosis of this potentially fatal liver complication in a healthy appearing male, the risk associated with the online trade of performance enhancing drugs and its relation with peliosis hepatis.

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.

Hepatic rupture from haematomas is a rare complication of severe preeclampsia/eclampsia especially when complicated with the haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. It is associated with poor maternal and foetal outcomes as demonstrated by three cases we describe. The first case had eclampsia at 31 weeks gestation with features of abruptio placentae and at caesarean section we found haemoperitoneum of 1.5 litres, a 10cm liver rupture and a still birth. She subsequently died in ICU within 24 hours of surgery; the second case had eclampsia at 35 weeks and ended up as a table death during emergency caesarean section. She had 4 litres of haemoperitoneum, hepatic rupture, placental abruption and a stillbirth; the third case had pre-eclampsia at 33 weeks with markedly elevated liver enzymes. She had one litre haemoperitoneum, right lobe hepatic rupture and a stillbirth. She recovered after conservative management. Severe pre-eclampsia/eclampsia associated hepatic rupture calls for rapid and aggressive intervention with prompt multidisciplinary management to avert adverse outcomes.

Spontaneous hepatic rupture during labour is a rare condition. Because of the difficulty in diagnosing hepatic rupture in pregnant women, it is often associated with a high mortality rate. Although pregnant women with HELLP syndrome are more prone to hepatic rupture, it can also occur with other liver pathologies and even in healthy women. We should be vigilant in case of suspicious clinical signs even if we have no evidence of preeclampsia. An early diagnosis will be the key to reducing the mortality and morbidity rate.

La rotura hepática espontánea es una complicación rara y de alta mortalidad, asociado al síndrome Hellp y preeclampsia severa. La incidencia de rotura hepática varía de 1 en 45 000 a 1 en 225 000 de todos los embarazos. Se relata la experiencia institucional de manejo y tratamiento de la rotura hepática asociada a preeclampsia severa y síndrome Hellp, en una mujer de 29 años, con gestación de 39 semanas, que acudió a la emergencia por dinámica uterina. Luego de 3 horas presentó epigastralgia, dolor en brazo derecho y plaquetopenia, por lo que se decidió culminar el embarazo por cesárea, con recién nacido Ápgar 8 y 9; se evidenció hemoperitoneo y solución de continuidad de la cápsula de Glisson y hematoma hepático. Se realizó taponamiento hepático. Al cuarto día se reintervino para el retiro de gasas, con éxito y evolución favorable.

Aggressive natural killer cell leukemia (ANKL) is a rare subtype of large granular lymphocyte (LGL) leukemia, which typically presents in young adults of Asian descent. It is an aggressive disease, characterized initially by fever, pancytopenia and hepatosplenomegaly, which rapidly progresses to organ failure and death over the course of months. Spontaneous hemorrhagic complications have been reported to occur in ANKL in a handful of case reports, including lethal intestinal and cerebral hemorrhage as well as splenic rupture. Here, we present a case of a 49-year-old man with Epstein-Barr virus (EBV)-negative ANKL who developed fatal spontaneous hepatic rupture approximately 4 months after initial diagnosis. To the best of our knowledge, this is first reported case of hepatic rupture associated with ANKL.

Primary intrahepatic malignant mesothelioma (PIHMM) is an extremely rare tumor with clinicopathological characteristics that remain to be elucidated. The current study presents the case of a 68-year-old female with PIHMM and multiple lymphadenopathies due to non-tuberculous mycobacteria. The patient presented with an intrahepatic tumor, 70 mm in diameter, in the right lobe of the liver. An ultrasound-guided fine-needle aspiration biopsy of the liver tumor revealed findings that were consistent with an intrahepatic malignant mesothelioma. The systemic lymph node swellings were due to epithelioid granulomas that were caused by non-tuberculous mycobacteria. However, a hepatic rupture occurred due to the rapid growth of the liver tumor and consequently, a surgical resection was not performed. A review of the literature revealed that the clinicopathological characteristics of PIHMM are similar to those of non-occupational mesothelioma. However, PIHMM is usually a solitary tumor and is rarely associated with cavity effusion in contrast with conventional mesothelioma. Therefore, surgical resection with curative intent is often recommended for patients with PIHMM.

Liver subcapsular haematoma and its consequence, spontaneous hepatic rupture, are very rare complications of pregnancy. They are mainly associated with pre-eclampsia. The diagnosis is difficult and the maternal and fetal mortality rates are high. We report the case of a spontaneous hepatic rupture on a normal liver during an uncomplicated twin pregnancy with a favorable outcome for both the mother and the newborns.

Spontaneous hepatic rupture is a rare clinical event associated with various pathologies of the liver. Most series to date reported the incidence and characteristics of a single etiology.Data were collected for all patients admitted with spontaneous hepatic rupture from 1995 to 2007.Ten patients met the study criteria. Hepatocellular adenoma was the cause of the rupture in six female patients, in their second to fourth decade. In the remaining patients, the ruptures were because of hepatocellular carcinoma in two, metastatic gastrointestinal stromal tumor in one, and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) in one. Nine out of 10 patients were treated surgically.Spontaneous hepatic rupture requires a high index of suspicion for a correct and timely diagnosis. Outcome is potentially grave and greatly depends on the underlying condition.

Rationale:Spontaneous and repeated hepatic ruptures caused by hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome are uncommon but life-threatening conditions that rarely occur early in the second trimester of pregnancy.Patient concerns:We describe a patient who experienced

Spontaneous hepatic rupture with hemoperitoneum is an uncommon but devastating complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Although the syndrome has been considered a variant of preeclampsia/eclampsia, its pathogenesis is not completely understood. Hepatic rupture increases the perinatal and maternal morbidity and mortality. This report describes 3 cases of extensive spontaneous hepatic rupture in pregnant women with HELLP syndrome. Early diagnosis and adequate tertiary management of this rare but life-threatening condition reduce the high maternal and newborn mortality.

Hepatic rupture is a rare and devastating complication in pregnancy, mainly associated with pre-eclampsia and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count). It has an incidence of 1 case in 45,000-225,000 births. Nearly 200 cases have been reported in the international literature. We report a case of a hepatic rupture with severe haemorrhage caused by HELLP in a third trimester pregnancy. The case was managed successfully with no pathological complications for either the mother or the infant. The physician should be aware of this condition when dealing with intra-abdominal haemorrhage during pregnancy.

Spontaneous hepatic rupture in pregnancy is rare and carries a high maternal and perinatal mortality. We describe a case of hepatic rupture that occurred after emergency caesarean section performed in a pregnant woman at 38 weeks of gestation with Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome. The patient was discharged after 30 days of intensive therapy and four explorative laparotomies. Today, 2 years after delivery, the patient and her baby are doing well. Hepatic rupture in pregnancy is a rare event that may complicate HELLP syndrome. In this case, we were able to achieve an excellent clinical outcome by the performance of an immediately explorative laparotomy.

Hepatic rupture is a rare condition, and treatment options are very limited. We report a case of hepatic rupture secondary to hereditary lysozyme amyloidosis that was successfully treated by liver transplantation. The mother of this patient had presented in an identical fashion 15 years earlier in the pretransplant era and died very rapidly.

Lysozyme (ALys) amyloidosis (Online Mendelian Inheritance in Man 153450), first identified in 1993 by Pepys et al., is a very rare autosomal dominant hereditary non-neuropathic amyloidosis [1]. Lys...

Rationale Currently, percutaneous catheter drainage (PCD) is regarded as the first-line treatment modality of pyogenic liver abscess. Severe complications associated with PCD were uncommon. Hepatic rupture is an uncommon but life-threatening liver trauma with high mortality. Its management is challenging because a delay in the diagnosis may lead to fatal hemorrhagic shock. To our knowledge, PCD-associated hepatic rupture has never been reported. Patient concerns We report herein a rare case of PCD-associated hepatic rupture. Its clinical courses and our therapeutic approaches are presented. Moreover, the clinical significance, underlying causes, and current views on severe liver trauma management will be discussed briefly. Diagnoses A diabetic patient suffering from fever and malaise was diagnosed with a pyogenic liver abscess. PCD was performed because intravenous antibiotics were ineffective. The patient developed a liver rupture following PCD, with clinical and imaging confirmation but without further progression. Interventions Surgical repair and vascular intervention were both inappropriate. As a result, medical treatments with supportive care were adopted and were found to be effective. Outcomes The patient's condition improved gradually, with stabilized imaging and laboratory performance. He recovered uneventfully during follow-ups. Lessons Hepatic rupture should be listed as an extremely rare but severe complication of PCD. Immediate suspicion and effective intervention may avoid an unfavorable consequence.

Hepatic rupture is a rare complication of severe preeclampsia with few cases having been reported in the literature. Most liver hematomas with subcapsular rupture occur antenatally but can occur in the postpartum period as well. Liver hematomas are a serious complication of severe preeclampsia but can be managed conservatively if the patient is stable. Hepatic rupture is a medical emergency and can be fatal if not properly diagnosed and treated. Sonography is an effective means of aiding in the diagnosis. Surgical intervention with delivery of the fetus and hepatic repair is essential for survival.

The complicated preeclamptic patient represents a challenge for the clinician faced with her antepartum or postpartum care. The most serious sequelae of preeclampsia account for a significant portion of maternal morbidity and mortality. Severe preeclampsia also results in an appreciable portion of perinatal morbidity and mortality. In this review, developing trends in the treatment of severe preeclampsia are discussed. Expectant treatment of the patient remote from term, anesthesia choices, and delivery route are reviewed. Developing trends in the pharmacological approach to complicated preeclampsia are discussed. New concepts in the treatment of cerebrovascular preeclampsia and hepatic rupture are outlined and reviewed.

HELLP syndrome without proteinuria or hypertension is rare. We present the case of a 33-year-old primigravid who initially was diagnosed with pulmonary embolism. The patient was readmitted with a diagnosis of subcapsular hematoma and eventually diagnosed with HELLP syndrome with a sequela of hepatic rupture.

A 42-year-old male patient with primary AL amyloidosis experienced spontaneous hepatic rupture, producing diffuse widespread intrahepatic hemorrhage. Transcatheter hepatic artery embolization saved his life. Hepatic rupture infrequently develops in patients with systemic amyloidosis, but survival after this complication is rare because surgical treatments seldom succeed. Non-invasive emergent transcatheter embolization should be considered for hepatic rupture caused by massive deposits of amyloid.

Spontaneous liver rupture mostly occurs in pregnant women with pre-eclampsia and its complications. It is extremely rare. The estimated incidence is between 0.4 and 2.2/100,000 pregnancies [1, 2]. We report a case of successful pregnancy outcome after initial pregnancy complicated by eclampsia and hepatic rupture. To our knowledge, only seven such cases have been reported in the literature to date.

We report a case of spontaneous hepatic rupture secondary to HELLP syndrome. A favourable evolution was observed after massive transfusion and surgical management limited to hepatic packing. Subcapsular hepatic haematoma is a rare complication of preeclampsia occurring mainly in the context of HELLP syndrome. A high maternal and foetal mortality is observed. Different therapeutic options are presented including medical, surgical and radiological interventions. A unique strategy cannot be defined. Multidisciplinary approach seems mandatory. Surgery should remain as less aggressive as possible.

The rupture of a metastatic mixed adenoneuroendocrine carcinoma (MANEC) has not been previously reported, although the neuroendocrine cell carcinoma is often associated with a high incidence of hepatic metastases. The patient was a 39-year-old male who presented with upper abdominal pain over 3 months. Computed tomography showed multiple tumors in both hepatic lobes, while lower gastrointestinal endoscopy revealed a tumor in the transverse colon. Histopathologic examination of the tumor revealed it to be a neuroendocrine cell carcinoma. After the resection of the primary tumor, hepatic metastases rapidly increased, and one of them in the left lateral segment was ruptured with significant hemorrhage. The rupture led us to undertake the emergency operation to stop the bleeding. Histology showed a high-grade large-cell neuroendocrine carcinoma associated with moderately differentiated tubular adenocarcinoma. The Ki-67 labeling index was 80% (G3). The diagnosis was mixed adenoneuroendocrine carcinoma according to the 2010 World Health Organization guidelines. Hepatic arterial infusion chemotherapy, systemic chemotherapy, and transcatheter arterial chemoembolization did not decrease the tumor progress, and the patient died on postoperative day 110. Reporting this highly malignant case, I hope all doctors can be interested in MANEC.