Hepatic haemorrhage

Case contributed by Dr Lawrence Josey

Presentation

Middle aged female admitted with decompensated chronic liver disease. Medical Emergency Response Team called due to hypotension. Ultrasound guided biopsy performed by an experienced interventional radiologist 2 days earlier. Gel Foam Plugs utilised at the time of the biopsy.

Patient Data

Age: 50
Gender: Female

Ultrasound identified free fluid within the abdomen, patient immediately transfered to CT for multiphase aquisition.

Modality: CT
Modality: DSA (angiography)

Case Discussion

Ongoing life-threatening liver bleeding (haemoperitoneum) post-liver biopsy in a patient with end stage cirrhosis and advanced liver failure. Bilirubin >400.

INR rapidly increased after the liver biopsy  indicating grossly impaired synthetic function. In the 12 hours prior to the attempted embolisation of the site of haemorrhage the patient was anuric with a systolic blood pressure having dropped to 60mmHg and requiring ICU support. Large volume transfusions of products were given to to correct the coagulopathy - INR reduced from 6.6 to 1.8. Post 5 unit blood transfusion - Hb had not improved.

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Case Information

rID: 18047
Case created: 3rd Jun 2012
Last edited: 28th Aug 2016
Inclusion in quiz mode: Included

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