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

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. A systematic se...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2024-03
Main Authors: Giannone, Fabio, Cinelli, Lorenzo, Bellissard, Arielle, Cherkaoui, Zineb, Felli, Emanuele, Saviano, Antonio, Mayer, Pierre, Pessaux, Patrick
Format: Article
Language:English
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Summary: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. A systematic search of the last 24-year literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines. 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). 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.
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-024-02500-3