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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

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.

Methods

A systematic search of the last 24-year literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines.

Results

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).

Conclusions

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.

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Data availability

No datasets were generated or analyzed during the current study.

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Authors and Affiliations

  1. Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 Place de L’Hôpital, 67100, Strasbourg, France

    Fabio Giannone, Arielle Bellissard, Zineb Cherkaoui, Emanuele Felli & Patrick Pessaux

  2. Institute of Image-Guided Surgery, University Hospital Institute (IHU), 1 Place de L’Hôpital, Strasbourg, France

    Fabio Giannone, Zineb Cherkaoui, Emanuele Felli & Patrick Pessaux

  3. Institute of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 1 Place de L’Hôpital, Strasbourg, France

    Fabio Giannone, Zineb Cherkaoui, Emanuele Felli, Antonio Saviano & Patrick Pessaux

  4. Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy

    Lorenzo Cinelli

  5. Gastroenterology and Hepatology Unit, University Hospital of Strasbourg, 1 Place de L’Hôpital, Strasbourg, France

    Antonio Saviano & Pierre Mayer

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  1. Fabio Giannone
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Contributions

Conceptualization: F. G., L. C., and P. P.; methodology: F. G. and L. C.; validation: F. G., E. F., A. S., P. M., and P. P.; formal analysis: F. G. and L. C.; investigation: F. G. and L. C.; data curation: F. G., L. C., and A. B.; writing—original draft preparation: F. G. and L. C.; writing—review and editing: A. B., E. F., Z. C., A. S., P. M., and P. P.; visualization: F. G. and L. C.; supervision: E. F. and P. P.; project administration: F.G. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Fabio Giannone.

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Fabio Giannone and Lorenzo Cinelli share the first authorship.

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Giannone, F., Cinelli, L., Bellissard, A. et al. Spontaneous idiopathic liver hemorrhage: a systematic review of a rare entity. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02500-3

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