[9] Acute Hepatic Hemorrhage in Hospital-Based Autopsy Series: A 21-Year Review

Shelley I Odronic, E Rene Rodriguez, Carmela D Tan. Cleveland Clinic, Cleveland, OH

Background: Acute hepatic hemorrhage can have a variety of causes. In this study, we reviewed the etiology and associated findings in hospital-based autopsy cases of liver hemorrhage.
Design: Retrospective search of subcapsular hematoma and liver laceration from a single medical center between 1990 and 2011 was performed. Fetuses and patients with liver transplantation or remote history of liver laceration were excluded.
Results: Thirteen cases of acute liver hemorrhage were found.

Causes of hepatic hemorrhage
CaseAge/SexEtiology for hepatic hemorrahgeHemoperitoneumDiagnosis made antemortemCause of deathClinical diagnosis
13/FCPRYesNoTransplant rejectionDilated cardiomyopathy S/P transplant
29/MCPRYesNoCerebral edemaRight temporal lobe cortical dysplasia
346/FCPRNoNoPulmonary embolismUterine leiomyomas S/P hysterectomy
466/FCPRYesYesSepsisAspiration pneumonia
569/FCPRYesNoHemopericardiumAcute myocardial infarction
675/Fendoscopic retrograde cholangiopancreatographyNoYesSepsisCholangiocarcinoma
758/Fportal vein stenting via transhepatic accessYesYesMassive hemoperitoneumPancreatic carcinoma
874/Mpercutaneous transhepatic cholangiographyYesYesCarcinomatosisCholangiocarcinoma
93/Ftranscatheter closure of ventricular septal defect via transhepatic accessYesNoMassive hemoperitoneumPulmonary atresia with ventricular septal defect
1029/FspontaneousYesNoMassive hemoperitoneumNephrolithiasis
1167/FspontaneousNoYesSepsisCoronary artery disease
1240/MspontaneousYesYesMassive hemoperitoneumEhlers-Danlos syndrome
1373/FtraumaYesYesMassive hemoperitoneumFall

There were 3 children and 10 adults with age ranging from 3 to 75 years. There was a female predominance (M:F ratio of 3:10). Nine cases were iatrogenic (64%), 3 cases were spontaneous (23%), and 1 case was traumatic (8%). Of the 9 iatrogenic cases, 5 were due to cardiopulmonary resuscitation (CPR) and 4 cases occurred after procedures related to the hepatobiliary system. Eight cases involved the right lobe, 4 cases involved the left lobe and 1 case involved both lobes. Three cases showed subcapsular hematoma that did not rupture. Ten cases were associated with hemoperitoneum which was the immediate cause of death in 5 patients. The clinical team was not aware of the hepatic hemorrhage prior to autopsy in 2 of the 5 cases with massive hemoperitoneum.
Conclusions: The occurrence of hepatic hemorrhage is extremely rare but can have grave consequences, particularly when it results in massive hemoperitoneum. Most cases of liver injury in the hospital setting were iatrogenic in nature.
Category: Autopsy

Wednesday, March 21, 2012 9:30 AM

Poster Session V # 5, Wednesday Morning


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