Liver Laceration Secondary to Resuscitation

A 79-year-old patient was resuscitated after ventricular fibrillation and received a DES (drug-eluting stent) for causal anterior myocardial infarction. The following day, free perihepatic fluid was demonstrated on abdominal ultrasound in the setting of an Hb drop. Emergency computed tomography revealed an axial 14.4 × 9.2-cm hematoma in the left hepatic lobe (Figure) with an intraparenchymal portion measuring 9.8 cm in diameter and subcapsular extension over approximately one-third of the surface of the liver (grade 2 according to the American Association for the Surgery of Trauma [AAST] liver injury scale) and accompanying perihepatic and perisplenic hemoperitoneum. No active bleeding or other trauma sequelae to upper abdominal organs, such as splenic laceration, or thoracic injury, such as rib fractures, were seen. In terms of operative management in the setting of hypovolemic shock, the liver laceration was surgically treated by suture repair, adhesion using a sealing matrix, and compression with abdominal bandages. Liver injuries, with a reported incidence of 0.6–3%, are the most common sequelae of abdominal trauma following resuscitation and are promoted by antithrombotic agents, as in this case by dual antiplatelet drugs.

Figure

Computed tomography of the upper abdomen in portal venous phase

Dr. med. Sebastian Zensen, PD Dr. med. Kai Nassenstein, Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, [e-mail]

Dr. med. Detlef Horn, Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Elisabeth-Krankenhaus Essen

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Chrstine Rye.

Cite this as: Zensen S, Horn D, Nassenstein K: Liver laceration secondary to resuscitation. Dtsch Arztebl Int 2022; 119: 417. DOI: 10.3238/arztebl.m2022.0018