A Case Report of a Low-Birth-Weight Infant With a Subcapsular Liver Hematoma and Spontaneous Bowel Perforation

Abstract

This case report describes a 27-week, 1040-g infant, whose mother presented with an acute abruption and fetal distress prompting emergency cesarean birth. The birth was further complicated by fetal malposition, manual version, birth trauma, and perinatal depression requiring intubation, ventilation, and chest compressions. On day of life (DOL) 7, the infant suddenly deteriorated with cardiovascular collapse and severe coagulopathy. Coexisting spontaneous bowel perforation (SBP) and ruptured subcapsular liver hematoma (SLH) were confirmed operatively. Although survival with ruptured SLH is rarely reported, with aggressive medical and surgical management, this infant survived and was discharged home at 43 weeks postconceptual age. SBP may occur silently; pneumoperitoneum may be an incidental finding. Conversely, rupture of an SLH typically presents with a sudden clinical deterioration. The common predisposing factor for both conditions is low birth weight (LBW). A review of the known and proposed risk factors, clinical signs and symptoms, pathophysiology, and treatment of both SBP and SLH are provided. A literature review highlighting the potential impact of drug exposures (indomethacin, hydrocortisone, and low molecular weight heparin) is provided, along with a discussion of the implications for clinical practice and research.

Subcapsular Liver Hematoma—A Life-Threatening Condition in Preterm Neonates—A Case Series and Systematic Review of the Literature

“…Surgical intervention may be provided for neonates who fail to respond to conservative management to improve prognosis of the ruptured SLH. Primary peritoneal drainage allows gradual release of intra-abdominal pressure, and hence the rapid enlargement of the liver, which could lead to spontaneous hemorrhage can be prevented [ 4 , 18 ]. Despite supportive treatment, liver rupture cannot always be avoided, having to deal with peritoneal hemorrhage.…”

“…Most information regarding the techniques for management of liver hemorrhage is emerging from the trauma literature [ 35 ]. One or more of the following techniques can be used by the surgeon to control bleeding from the liver: application of topical hemostatic agents or argon beam coagulation, manual compression, suture hepatorraphy, intrahepatic vessel ligation, selective hepatic arterial ligation, partial resection, and formal hepatic lobectomy [ 18 , 36 ]. Our proposed algorithm for the management of a newborn with this condition is presented in Figure S2 .…”

“…A total of 39 articles reported 433 cases SLH, in neonatal population [ 2 , 3 , 4 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The characteristics of the reported cases are summarized in Table S1 .…”

“…Review data regarding the diagnosis methods and treatment. References [ 2 , 3 , 4 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] are cited in the Supplementary Materials.…”

Unexpected extensive hemorrhage from a subcapsular hematoma of the liver during emergent laparotomy in a premature neonate

“…Abnormal conditions during labor such as a breech presentation or oversized infants, increase the incidence of trauma. Traumatic umbilical venous catheterization and cardiopulmonary resuscitation have also been reported to induce hepatic rupture 1,2,6. Moreover, many cases of SHL are related to coagulopathy.…”