Spontaneous liver rupture: A report of two cases
A 26-year-old man presented to emergency department with abdominal pain for five days. He had no vomiting or altered bowel habits. There was no history of trauma or other co-morbidities. On admission he was in shock with heart rate of 120 per minute and blood pressure not recordable. Abdomen was distended and non tender. There were no signs of peritonitis. Laboratory investigations showed hemoglobin of 5.4 gm/dl, white cell count 7.800/cmm, platelet count 1.3 lacs/ccL and INR 1.01. Liver function tests showed normal bilirubin, albumin, and enzymes.\nFocused abdominal sonogram for trauma (FAST) showed free fluid with hyper echoic area in the abdomen. Hemoperitoneum was suspected and contrast-enhanced CT revealed large sub capsular hematoma with hemoperiotneum. There were no cysts or hemoangiomas of the liver. At emergency laparotomy, there was two liters of altered blood in the peritoneal cavity with a large ruptured hematoma over the seven and eight segments of the liver. Other solid viscera and bowel were normal. Peritoneal wash and peri hepatic packing was done with gel foam. He received six units of blood. The routine investigations for common conditions with liver rupture were normal. He had uneventful post operative period and recovered with no morbidity. The HPE of the liver tissue revealed extensive hemorrage and mild to moderate steatosis. He was asymptomatic on follow-up a year ago [].