Ultrasonographic diagnosis of spontaneous rupture of the liver in pregnancy

✍ Scribed by Fernando H. Greca; Julio C. U. Coelho; Odilon D. Barros Filho; Alfredo Wallbach

• Publisher: John Wiley and Sons
• Year: 1984
• Tongue: English
• Weight: 221 KB
• Volume: 12
• Category: Article
• ISSN: 0091-2751
• DOI: 10.1002/jcu.1870120813

✦ Synopsis

Spontaneous rupture of the liver associated with pregnancy is a rare and catastrophic complication. Since Abercrombie's first description in 1844, isolated cases have been reported mainly in the obstetric literature and, until 1977, no more than 115 cases of spontaneous hepatic rupture have been described.' Early diagnosis and management are mandatory to avoid high maternal and fetal mortalities.2

Preoperative diagnosis is infrequent and has usually been based on radioisotopic liver scans.2 Sommer et al. have recently employed celiac and selective hepatic arteriography and have also cited the use of ultrasonography in the diagnosis of one case of spontaneous hepatic rupture during p r e g n a n ~y . ~

The detailed ultrasonographic features of this rare disease are presented.

CASE REPORT

A 23-year-old woman, gravida 3, para 2, was admitted to the hospital in the 29th week of pregnancy with a history of uterine bleeding. She had not had regular prenatal care and her medical history included high blood pressure and the use of oral contraceptives. A diagnosis of placenta previa was confirmed by ultrasonography. Two units of whole blood were transfused and the patient was discharged.

Fifteen days later, the patient was readmitted with severe right upper quadrant abdominal pain and slight uterine bleeding. Her blood pressure was 80/60 mmHg and her pulse was 130/min. The right upper quadrant of the abdomen was tender and no rigidity or rebound tenderness was elicited. The liver was not palpable.