Hepatic hematoma: a challenging, emergency disease - 18/03/23
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Hepatic hematoma, a rare but severe disease, may follow liver injury, preexisting vascular diseases, interventional, diagnostic and therapeutic procedures.
It is prone to further complications, such as rupture, internal hemorrhage, haemobilia, overinfection, and hepatic compartment syndrome, generating a retro-hepatic vena cava compression, or a “sectorial Budd-Chiari like syndrome”.
Ultrasound and mainly Computed Tomography and Magnetic Resonance Imaging are essential diagnostic tools, which also facilitate percutaneous drainage or selective vascular embolization.
Elective surgery consists usually of an open or laparoscopic fenestration or partial resection of its walls, and rarely of a total peri-cystectomy, or hepatic resection.
Hepatic hematoma (HH) consists of a collection of blood and clots inside the liver, with various etiologies: traumatic, pre-existing macro/micro vascular disease, previous diagnostic/interventional procedures, and open or laparoscopic operations. Clinically, it may go unnoticed when its signs are mild or non-specific; otherwise, it may be followed by challenging emergency complications.
Our experience, although limited, allowed to study some pathophysiological features and role of diagnostic and therapeutic procedures.
Abundant hepatic vascularization is a predisposing factor for HH. Its progressive expansion may be promoted by a self-feeding mechanism of compression, ischemia and necrosis of the surrounding liver parenchyma. Differently, high internal tension may cause a parietal tear, while a large HH, due to mass effect, may produce a secondary hepatic compartment syndrome through compression on the inferior vena cava, or a sectoral 'Budd-Chiari-like' syndrome, characterized by downstream portal venous congestion.
HH requires a careful diagnostic study, preferably by CT or MRI, especially when complicated by rupture, internal hemorrhage, haemobilia, hepatic compartment syndrome or acute infection. Treatment varies from a percutaneous drainage and selective vascular embolization, to surgical parietal fenestration and hepatic resection.Le texte complet de cet article est disponible en PDF.
Key words : Hepatic hematoma, Hepatic hematoma complications, Liver compartment syndrome, Budd-Chiari-like sectorial syndrome, Venous hemobilia
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