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. 2024 Dec;50(6):2765-2774.
doi: 10.1007/s00068-024-02500-3. Epub 2024 Mar 19.

Spontaneous idiopathic liver hemorrhage: a systematic review of a rare entity

Fabio Giannone  1   2   3 , Lorenzo Cinelli  4 , Arielle Bellissard  5 , Zineb Cherkaoui  5   6   7 , Emanuele Felli  5   6   7 , Antonio Saviano  7   8 , Pierre Mayer  8 , Patrick Pessaux  5   6   7
Affiliations

Spontaneous idiopathic liver hemorrhage: a systematic review of a rare entity

Fabio Giannone et al. Eur J Trauma Emerg Surg. 2024 Dec.

Abstract

Background: Spontaneous idiopathic liver hemorrhage (SILH) is a rare life-threatening condition occurring without a clear and specific etiology. A systematic review was performed to provide guidelines for the perioperative management of patients affected by SILH. A case report was also included.

Methods: A systematic search of the last 24-year literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines.

Results: After an initial selection of 6995 titles, 15 articles were considered for the final qualitative analysis (n = 22 patients, including the present report). Conservative treatment was chosen in 12 cases (54.5%) with stable clinical conditions, while 9 patients (40.9%) required a primary operative approach for emergency presentation at diagnosis. Direct liver resection was the preferred surgical treatment (n = 6), mostly major hepatectomies (n = 4). Hepatic arterial embolization was performed as the primary operative approach in three patients, followed by emergency laparotomy during the same hospitalization because of rebleeding in one case. Contrast-enhanced CT scan was the gold standard for diagnosis (n = 19).

Conclusions: Conservative treatment of SILH is mainly based on stable clinical conditions and may be considered even in case of a limited arterial blush found on imaging. The absence of underlying hepatic or systemic disorders seems to correlate with favorable outcomes and no mortality.

Keywords: Hepatic hematoma; Idiopathic; Liver hemorrhage; Spontaneous; Systematic review.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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