[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

Case	Age/Sex	Etiology for hepatic hemorrahge	Hemoperitoneum	Diagnosis made antemortem	Cause of death	Clinical diagnosis
1	3/F	CPR	Yes	No	Transplant rejection	Dilated cardiomyopathy S/P transplant
2	9/M	CPR	Yes	No	Cerebral edema	Right temporal lobe cortical dysplasia
3	46/F	CPR	No	No	Pulmonary embolism	Uterine leiomyomas S/P hysterectomy
4	66/F	CPR	Yes	Yes	Sepsis	Aspiration pneumonia
5	69/F	CPR	Yes	No	Hemopericardium	Acute myocardial infarction
6	75/F	endoscopic retrograde cholangiopancreatography	No	Yes	Sepsis	Cholangiocarcinoma
7	58/F	portal vein stenting via transhepatic access	Yes	Yes	Massive hemoperitoneum	Pancreatic carcinoma
8	74/M	percutaneous transhepatic cholangiography	Yes	Yes	Carcinomatosis	Cholangiocarcinoma
9	3/F	transcatheter closure of ventricular septal defect via transhepatic access	Yes	No	Massive hemoperitoneum	Pulmonary atresia with ventricular septal defect
10	29/F	spontaneous	Yes	No	Massive hemoperitoneum	Nephrolithiasis
11	67/F	spontaneous	No	Yes	Sepsis	Coronary artery disease
12	40/M	spontaneous	Yes	Yes	Massive hemoperitoneum	Ehlers-Danlos syndrome
13	73/F	trauma	Yes	Yes	Massive hemoperitoneum	Fall

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