Hepatic hematoma: a challenging, emergency disease - 18/03/23
, L. Roncati b, G. Manco a, A. Farinetti a, F. Coppi c
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Highlights |
• | 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. |
Abstract |
Background |
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.
Methods |
Our experience, although limited, allowed to study some pathophysiological features and role of diagnostic and therapeutic procedures.
Results |
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.
Conclusions |
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
Plan
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