An elusive cause of haemoperitoneum complicating cardiac surgery — hepatic tear
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Abstract
Aim-background
We report an unusual source of intraoperative bleeding in a patient undergoing cardio surgical reoperation.
Case report
After sternotomy, the haematocrit dropped significantly. This was ascribed to intraoperative bleeding from adhesions. During reperfusion, the abdominal wall was distended with a bluish bulge in the right hemidiaphragm.
Results
Immediate laparotomy revealed bleeding from a tear in the right hepatic lobe without evidence of injury to the diaphragm. The tear was likely caused by blunt trauma from an oscillating saw.
Conclusion
We stress caution when using an oscillating saw on patients with hepatic congestion undergoing a repeat sternotomy. We propose that lifting the sternum in redo procedures might prevent a hepatic tear.
Key words
Intraoperative complication haemoperitoneum cardiac surgical procedures hepatic tear sternotomy diaphragmPreview
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