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Hemoperitoneum caused by hepatic necrosis and rupture following a snakebite: a case report with rare CT findings and successful embolization.

Ahn JH, Yoo DG, Choi SJ, Lee JH, Park MS, Kwak JH, Jung SM, Ryu DS - Korean J Radiol (2007 Nov-Dec)

Bottom Line: We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Foundation, GangNeung Asan Hospital, University of Ulsan College of Medicine, Sachun-Myun, Gangneung, Korea.

ABSTRACT
We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.

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Related in: MedlinePlus

A follow-up enhanced CT scan after embolization performed 16 weeks later shows a decrease in size of the post-hemorrhagic pseudocyst as well as gradual atrophy of the right lobe of the liver (arrow).
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Figure 4: A follow-up enhanced CT scan after embolization performed 16 weeks later shows a decrease in size of the post-hemorrhagic pseudocyst as well as gradual atrophy of the right lobe of the liver (arrow).

Mentions: An unenhanced CT revealed a high attenuation of fluid collection in the whole abdominal and pelvic cavity. The study subject's perihepatic hematoma-yielding attenuations were 20-50 HU (Fig. 1A) and a contrast-enhanced CT showed an irregular interface (Fig. 1B) between the hepatic parenchyma and perihepatic hematoma; presumably representing the site of hepatic rupture and multiple active contrast extravasations from the irregular hepatic surface (Fig. 1C). A conventional celiac angiogram (Fig. 2A) showed multiple small contrast extravasations in the peripheral branch of both hepatic arteries. The right inferior phrenic angiogram (Fig. 2B) also showed focal contrast extravasation. The embolization of both hepatic arteries with a small volume of gelatin sponge sheet (Spongostan; Johnson & Johnson, Skipton, UK) until the occlusion of the fourth or fifth ordered branch of the right and left hepatic arteries, and selective coil embolization of the right inferior phrenic artery were performed. The post-embolization angiogram (Fig. 2C) revealed no evidence of contrast extravasation. The general condition of the patient improved gradually, with an increase in serum hemoglobin to 12.3 g% with the coagulation profile corrected to normal levels. A follow-up contrast-enhanced CT (Fig. 3) two weeks after embolization showed a large post-hemorrhagic pseudocyst formation in the necrotic right lobe of the liver and perihepatic space. A follow-up CT (Fig. 4), 16 weeks after embolization, showed a decrease in the size of the post-hemorrhagic pseudocyst after the insertion of a drainage tube and gradual atrophy of the right lobe of the liver.


Hemoperitoneum caused by hepatic necrosis and rupture following a snakebite: a case report with rare CT findings and successful embolization.

Ahn JH, Yoo DG, Choi SJ, Lee JH, Park MS, Kwak JH, Jung SM, Ryu DS - Korean J Radiol (2007 Nov-Dec)

A follow-up enhanced CT scan after embolization performed 16 weeks later shows a decrease in size of the post-hemorrhagic pseudocyst as well as gradual atrophy of the right lobe of the liver (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627461&req=5

Figure 4: A follow-up enhanced CT scan after embolization performed 16 weeks later shows a decrease in size of the post-hemorrhagic pseudocyst as well as gradual atrophy of the right lobe of the liver (arrow).
Mentions: An unenhanced CT revealed a high attenuation of fluid collection in the whole abdominal and pelvic cavity. The study subject's perihepatic hematoma-yielding attenuations were 20-50 HU (Fig. 1A) and a contrast-enhanced CT showed an irregular interface (Fig. 1B) between the hepatic parenchyma and perihepatic hematoma; presumably representing the site of hepatic rupture and multiple active contrast extravasations from the irregular hepatic surface (Fig. 1C). A conventional celiac angiogram (Fig. 2A) showed multiple small contrast extravasations in the peripheral branch of both hepatic arteries. The right inferior phrenic angiogram (Fig. 2B) also showed focal contrast extravasation. The embolization of both hepatic arteries with a small volume of gelatin sponge sheet (Spongostan; Johnson & Johnson, Skipton, UK) until the occlusion of the fourth or fifth ordered branch of the right and left hepatic arteries, and selective coil embolization of the right inferior phrenic artery were performed. The post-embolization angiogram (Fig. 2C) revealed no evidence of contrast extravasation. The general condition of the patient improved gradually, with an increase in serum hemoglobin to 12.3 g% with the coagulation profile corrected to normal levels. A follow-up contrast-enhanced CT (Fig. 3) two weeks after embolization showed a large post-hemorrhagic pseudocyst formation in the necrotic right lobe of the liver and perihepatic space. A follow-up CT (Fig. 4), 16 weeks after embolization, showed a decrease in the size of the post-hemorrhagic pseudocyst after the insertion of a drainage tube and gradual atrophy of the right lobe of the liver.

Bottom Line: We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Foundation, GangNeung Asan Hospital, University of Ulsan College of Medicine, Sachun-Myun, Gangneung, Korea.

ABSTRACT
We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.

Show MeSH
Related in: MedlinePlus