Peliosis hepatis: Personal experience and literature review

Abstract

Peliosis hepatis (PH) is a disease characterized by multiple and small, blood-filled cysts within the parenchymatous organs. PH is a very rare disease, more common in adults, and when it affects the liver, it comes to the surgeon's attention only in an extremely urgent situation after the lesion's rupture with the resulting hemoperitoneum. This report describes the case of a 29-year-old woman affected by recurring abdominal pain. Computed tomography scans showed a hepatic lesion formed by multiple hypodense areas, which showed an early acquisition of the contrast during the arterial phase. Furthermore, it remained isodense with the remaining parenchyma during the late venous phase. We decided on performing a liver resection of segment VII while avoiding a biopsy for safety reasons. The histopathologic examination confirmed the diagnosis of focal PH. PH should always be considered in the differential diagnosis of hepatic lesions. Clinicians should discuss the possible causes and issues related to the differential diagnosis in addition to the appropriate therapeutic approach. The fortuitous finding of a lesion, potentially compatible with PH, requires elective surgery with diagnostic and therapeutic intents. The main aim is to prevent the risk of a sudden bleeding that, in absence of properly equipped structures, may have a fatal outcome.

Spontaneous hepatic rupture in a bodybuilder: a case report and review of the literature

“…When these lesions rupture and cause a potentially fatal hemoperitoneum, treatment is usually surgical, including transarterial embolization, hepatic resection and liver transplant (2). The present case did not report any past medical condition that may be associated with the finding of PH, except for the chronic use of clenbuterol and ephedrine and the possible use of AAS.…”

“…(1) and nowadays remains a rare condition associated with a high mortality rate and without standardized treatment (2). The condition results from a breach in the hepatic parenchyma that occurs without an external cause.…”

Chronic liver injury induced by drugs and toxins

“…It is usually asymptomatic, but may present with fatal hemoperitoneum due to cyst rupture. The pathogenesis is unclear, but it has been proposed that an altered outflow leads to damage to the wall of the sinusoids and subsequently dilatation of the central vein …”

“…A number of drugs have been associated with this pattern, including anabolic steroids, oral contraceptives, tamoxifen, methotrexate, thiopurines and iron chelators . Upon anabolic steroids withdrawal, peliosis hepatis usually reverts, although it may take longer than 6 months .…”

“…The pathogenesis is unclear, but it has been proposed that an altered outflow leads to damage to the wall of the sinusoids and subsequently dilatation of the central vein. 34 A number of drugs have been associated with this pattern, including anabolic steroids, oral contraceptives, tamoxifen, methotrexate, thiopurines and iron chelators. [34][35][36][37][38][39] Upon anabolic steroids withdrawal, peliosis hepatis usually reverts, although it may take longer than 6 months.…”