Hepatic hematoma and rupture during pregnancy

Introduction to hepatic hematoma and rupture during pregnancy Liver hematoma and rupture during pregnancy is a rare and serious complication that occurs in patients with severe pregnancy-induced hypertension with liver damage. The patient has pain in the upper right abdomen, tenderness in the liver area, and rebound tenderness. As the disease progresses, due to excessive stretching of the liver capsule, traction of the liver ligament, stimulation of the rupture of the capsule and hemorrhage, abdominal pain is aggravated, accompanied by radiation pain in the right shoulder and intra-abdominal hemorrhage, and symptoms and signs of acute blood loss. Since most of the liver hematoma and rupture literature are scattered cases, the estimation of the incidence rate is very difficult, the incidence rate is 1 ~ 1.36 / 10000 ~ 15000 pregnancy, but the maternal and infant mortality rate is as high as 60% ~ 70%. basic knowledge The proportion of the disease: the incidence rate of pregnant women is about 0.01% - 0.02% Susceptible population: pregnant women Mode of infection: non-infectious Complications: renal failure, diffuse intravascular coagulation, pleural effusion

Hepatic hematoma and rupture cause during pregnancy

(1) Causes of the disease

Pregnancy-induced hypertension is the main cause of hepatic hematoma and rupture, including pre-eclampsia, eclampsia, HELLP syndrome, etc. In addition, liver tumors, liver abscesses, acute fatty liver, trauma, etc. can also cause liver hematoma and rupture, Henny et al. Of the 73 cases of hepatic hematoma rupture reported in the literature in 1983, 82% of the cases were maternal, with an average age of 31.7 years (21-46 years); very few were primiparas, young, no typical pre-eclampsia, There may be different pathogenesis, the ratio of maternal to primipara is 10:1, most cases occur in the third trimester of pregnancy, short-term pregnancy or short-term delivery; rarely occurs in the early and middle pregnancy, Sibai et al reported 442 In the case of HELLP syndrome, the incidence of liver rupture was found to be 1%, indicating that HELLP is a high risk group for liver rupture.

(two) pathogenesis

The pathophysiological mechanism of liver hematoma and rupture during pregnancy is not fully understood. The autopsy shows that liver fibrosis, hepatocyte necrosis, hepatic parenchymal hemorrhage and intravascular coagulation are often accompanied by liver fibrosis to promote vascular proliferation. Vascular rupture, leading to intrahepatic hemorrhage, tissue rupture, hepatic subcapsular hematoma formation, further penetrating the hepatic fibrosis, causing hemorrhage, peritonitis, and even death. The mechanism of hepatic parenchymal hemorrhage leading to hepatic capsule hematoma is different from traumatic liver rupture. In the liver rupture caused by trauma, rupture precedes hemorrhage. Because the histopathological changes of the liver are similar to severe pre-eclampsia, it is thought that it may be that the blood vessels of the liver increase sensitivity to vasoactive substances, leading to hepatocyte necrosis, endothelial damage and liver parenchyma. Bleeding.

Liver rupture often occurs at the lower end of the right lobe of the liver. Although hepatic parenchymal hemorrhage can occur throughout the liver, 74% of hematomas occur in the anterior wall of the right lobe of the liver, only 11% of which are confirmed to occur in the left lobe, and 15% Unexplained, in the presence of hepatic subcapsular hematoma, vomiting, childbirth, and increased slight abdominal pressure, such as patient movement, can rupture the hematoma.

Hepatic hematoma and rupture prevention during pregnancy

There is no effective preventive measure for this disease. Early detection and early treatment are the key to prevention.

Hepatic hematoma and rupture complications during pregnancy Complications, renal failure, diffuse intravascular coagulation, pleural effusion

The main complications are liver, renal failure, DIC, respiratory distress syndrome, pleural effusion, subgingival infection, and rebleeding after surgery.

Hepatic hematoma and rupture symptoms during pregnancy Common symptoms Abdominal pain, nausea, pregnancy-induced hypertension, fetal distress, shock, mobile, voiced, sclerosing, hepatic pain, internal bleeding

1. Hepatic subdural hematoma rupture during pregnancy

Occurred in patients with severe pregnancy-induced hypertension with liver damage, the patient has pain in the upper right abdomen, tenderness in the liver area and rebound tenderness. As the disease progresses, due to excessive stretching of the liver capsule, traction of the liver ligament, rupture of the capsule and bleeding Stimulation, abdominal pain increased, accompanied by radiation pain in the right shoulder and intra-abdominal hemorrhage, acute blood loss symptoms and signs, the literature reported that the disease occurred in the postpartum or cesarean section of the latter, so pregnant women with pathogenic factors, after delivery Continue to observe to prevent missed diagnosis.

2. Liver cancer rupture

The patient has a history of liver cancer, some patients have been considered to have hepatitis or cirrhosis, and many patients have no previous symptoms and sudden liver rupture, small rupture of the right upper abdomen, mild pain, more limited, often by the greater omentum Wrap and natural hemostasis, pain relief, if the breach is large, bleeding is frequent, the incidence is sharp, the symptoms are critical, the patient has sudden upper right abdominal pain, accompanied by abdominal distension, nausea and vomiting, pale, cold sweat, fast pulse, and finally Shock, abdominal examination has obvious tenderness, peritoneal irritation and mobile dullness, etc., the condition often develops rapidly, not timely rescue, can be life-threatening.

Examination of hepatic hematoma and rupture during pregnancy

Elevated liver enzymes and decreased platelets in pregnant women with pregnancy-induced hypertension suggest an increased risk of hepatic hematoma, but do not indicate the presence of hepatic hematoma.

Abdominal puncture to extract non-coagulant; B-ultrasound see liver area occupying lesions and subcapsular hematomas or liquid dark areas can be clearly diagnosed, if necessary, CT scan can be seen in the lower edge of the hepatic capsule crescent or Lenticular low density effusion zone.

Diagnosis and diagnosis of hepatic hematoma and rupture during pregnancy

diagnosis

According to the medical history, clinical manifestations and hepatic hematoma and rupture that can not be diagnosed by auxiliary examination, in many cases, it can often be diagnosed after exploratory laparotomy, but early diagnosis, timely examination can strive for diagnosis before rupture of hepatic envelope hematoma, for timely and effective treatment Very helpful.

When pregnant women in the third trimester of pregnancy have both severe pregnancy-induced hypertension, right upper quadrant pain and acute blood pressure reduction, clinically highly suspected hepatic hematoma rupture, indications for exploratory laparotomy, and another case of cesarean section due to fetal distress Surgery, intraoperative intra-abdominal hemorrhage found in non-uterine origin should be considered for the possibility of liver rupture, and comprehensive abdominal exploration is required.

Differential diagnosis

Hepatic hematoma and rupture is a kind of obstetric acute abdomen. It should be differentiated from uterine rupture, ovarian cyst torsion, severe hepatitis, pancreatitis, gastroenteritis, myocardial infarction, pulmonary embolism, and urinary system diseases.

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