Hematoma hepático espontáneo, serie de casos. Hospital San Bartolomé, junio 2014-mayo 2018 / Spontaneous hepatic hematoma, case series. Hospital San Bartolomé, June 2014-May 2018

Objectives: To determine the incidence, epidemiological and clinical characteristics and medical-surgical management of patients with spontaneous hepatic hematoma (SHH) associated to the HELLP syndrome. Design: Descriptive, retrospective series of cases. Institution: Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru. Participants: Women diagnosed with SHH. Interventions: Review of medical records of patients with SHH attended in the period May 2014 May 2018. Results: We found eight cases of SHH, with an incidence of 1/3 632 births. The average maternal age was 32 years; all of them were multiparous, 62.5% with full-term pregnancies. The most frequent symptom was epigastric pain. Initial diagnosis of severe preeclampsia was determined in 62.5% of the cases, and all of them progressed to HELLP syndrome. Intracesarean SHH occurred in 37.5% of the cases and 62.5% presented in the puerperium. Initial surgical management was hepatic packing in 62.5%. All patients were hospitalized in the women's intensive care unit (ICU) and 75% required blood transfusion or other blood products. The most frequent complications were anemia and liver abscess (75%). The average hospital stay was 27 days. There was one maternal death (12.5%). Conclusions: Hepatic hematoma is an obstetric emergency at our hospital with high risk of mortality and extreme morbidity. Clinical suspicion and early diagnosis were tools for timely decision making; surgical management was predominant.

Objetivos. Determinar la incidencia, características epidemiológicas y clínicas y el manejo de pacientes con hematoma hepático espontáneo (HHE) asociado a síndrome HELLP. Diseño. Estudio descriptivo, retrospectivo, tipo serie de casos. Institución. Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú. Participantes. Mujeres con diagnóstico de HHE. Métodos. Revisión de historias clínicas de pacientes con HHE en el periodo junio de 2014 a mayo de 2018. Resultados. Se encontró 8 casos de HHE, incidencia de 1/3 632 nacimientos. La edad promedio fue 32 años, 100% fueron multíparas, 62,5% eran gestaciones a término, el síntoma más frecuente fue epigastralgia. El diagnóstico inicial de preeclampsia severa estuvo presente en 62,5% de los casos y todos evolucionaron a síndrome HELLP. En 37,5% se halló el HHE intracesárea y 62,5% se presentó en el puerperio. En 62,5% se realizó manejo quirúrgico inicial con empaquetamiento hepático. El 100% requirió UCI materna y 75% demandó transfusión sanguínea y/o de derivados. Las complicaciones más frecuentes fueron anemia y absceso hepático (75%). La estancia hospitalaria promedio fue 27 días. Se encontró una muerte materna (12,5%). Conclusiones. El hematoma hepático en nuestro hospital es una emergencia obstétrica por el riesgo elevado de mortalidad y morbilidad extrema, siendo la sospecha clínica y el diagnóstico temprano herramientas valiosas para la toma oportuna de decisiones; predominó el manejo quirúrgico.

Rotura hepática en gestante residente en gran altura y la utilidad del monitoreo hemodinámico con doppler transesofágico / Hepatic rupture in a pregnant woman resident at high altitude and the usefulness of hemodynamic monitoring with transesophageal Doppler

RESUMEN 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.

ABSTRACT 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

Hematoma hepático subcapsular en síndrome HELLP en un hospital de referencia de Lima / Subcapsular hepatic hematoma in HELLP syndrome in a Lima reference hospital

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).

Contrast Enhanced Ultrasound-guided Percutaneous Injection of Thrombin in the Treatment of Hemorrhage After Percutaneous Liver Biopsy:Case Report / 中国微创外科杂志

[Summary] This paper reported a patient suffering from hemorrhage after percutaneous liver biopsy treated by contrast enhanced ultrasound-guided percutaneous injection of thrombin in June 2015.Firstly,we performed contrast-enhanced ultrasound examination to find the position of active bleeding.And then,percutaneous injection of thrombin was performed under the guidance of ultrasonography.The active bleeding was stopped successfully.

Hemoperitoneum Caused by Hepatic Necrosis and Rupture Following a Snakebite: a Case Report with Rare CT Findings and Successful Embolization

We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.

A case of spontaneous hepatic rupture in a patient with primary hepatocellular carcinoma during the puerperium / 대한산부인과학회지

Hepatocellular carcinoma associated with pregnancy is rarely encountered, since hepatocellular carcinoma is usually developed after childbearing ages and severe menstrual irregularity and infertility with disturbance of estrogen metabolism is often accompanied with cirrhosis that is a most common underlying disease of primary hepatocellular carcinoma. Spontaneous hepatic rupture in pregnancy is a rare condition associated with significant maternal and perinatal mortality and could be developed related with severe preeclampsia and especially HELLP syndrome but possible related with hepatocellular carcinoma. We report a case of spontaneous hepatic rupture during the puerperium in a patient with hepatocellular carcinoma with a brief review of literatures.

Postpartum Spontaneous Intrahepatic Hemorrhage and Hepatic Rupture in the HELLP Syndrome / 대한산부인과학회잡지

The HELLP syndrome, which is characterized by hemolysis, elevated liver enzymes and low platelets, complicates 4 to 14% of preeclamptic or eclamptic pregnancy. Its course is usually benign except when spontaneous hepatic rupture, a rare catastrophic event, threatens life. The authors have experienced one case of spontaneous hepatic rupture in HELLP syndrome during immediate postpartum period, which was treated with surgical intervention on the first postpartum day. We report this case with a brief review of the literatures.

Spontaneous Hepatic Rupture Following an Uncomplicated Pregnancy and Delivery / 한국간담췌외과학회지

Spontaneous rupture of the liver in pregnancy is extremely uncommon. The most of cases have occurred in pregnancy with preeclampsia/eclampsia. We report one case of spontaneous capsular rupture following an uncomplicated pregnancy. A 33 year old woman was admitted at 38 weeks of gestation to the Obstetrics department. On admission her pulse and blood pressure were normal and there was no proteinuria. On the next day, a cesarean section was performed with delivery of a male infant (3.8 kg). but persistent uterine bleeding was developed due to uterine atony. and then subtotal hysterectomy was performed. Postoperatively she was remained unstable requiring further transfusion of blood and fresh frozen plasma. She was reoperated for controling persistent bleeding and evacuation hematoma of previous hysterectomy site. Postoperatively she was stable during 48 hours. However she again became hypotensive and on examination was noted intra-abdominal fresh bleeding. Laboratory evaluation demonstrated a high level of LFT. Contrast enhanced CT revealed subcapsular hematoma rupture and active bleeding of liver. We tried to embolized the terminal hepatic arterial branch for controling the ruptured subcapsular hematoma. and then she was stable but after 5th days, liver necrosis was developed and progressed to abscess. Despite radiologic drainage, necrotic abscess was remained persistently. She was managed with open drainage and debridement of necrotic liver. After 2 weeks, she was discharged without any morbidity.