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Liver Rupture Complicating Toxemia of Pregnancy: An Example of Thrombohemorrhagic Disease

Liver Rupture Complicating Toxemia of Pregnancy: An Example of Thrombohemorrhagic Disease Abstract A MULTIPAROUS toxemic postpartum patient sustained a subcapsular hemorrhage of the liver with rupture and shock and survived following a laparotomy. In reviewing the literature on the clinical aspects of 35 cases, we found that this is the sixth patient who survived. A liver biopsy showing hemorrhagic necrosis and periportal fibrin precipitation, and the clinical course and laboratory data presented below suggests that this is an example of disseminated intravascular coagulation as postulated by McKay.1 The role of fibrinolysis as a consequence of coagulopathy was not assessed. The clinical history and findings in the reported cases2-13 have a striking similarity. Hence, a syndrome is recognizable, and a preoperative diagnosis can be made. Given a multipara, usually in her thirties, with toxemia of pregnancy who develops severe pain of the right upper quadrant with vomiting and profound shock, without external blood loss, a diagnosis of subcapsular hemorrhage of the References 1. McKay, D.G.: Disseminated Intravascular Coagulation; an Intermediary Mechanism of Disease , New York: Paul B. Hoeber, Inc, Medical Bk. Dept. of Harper & Row, 1965. 2. Rademaker, L.: Spontaneous Rupture of Liver Complicating Pregnancy , Ann Surg 118:396-401, 1943.Crossref 3. Links, H.: Spontaneous Rupture of the Liver Complicating Pregnancy , Brit Med J 1:275-276 ( (Feb 23) ) 1946.Crossref 4. Burton-Brown, J.R.C., and Shepherd, J.A.: Rupture of the Liver Associated With Parturition , Brit Med J 1:941-943 ( (May 28) ) 1949.Crossref 5. Kramish, D.; Auer, E.S.; and Reckler, S.M.: Spontaneous Rupture of the Liver During Pregnancy , Obstet Gynec 4:21-28, 1954. 6. Baens, A., and Santos-Ocampo, C.C.: Spontaneous Rupture of the Liver in Eclampsia , Phillipp J Surg 14:351-354, 1959. 7. Mahon, R.: La Rupture Spontanée du Foie au Cours de la Grossesse , Rev Franc Gynec Obstet 58:751-764, 1963. 8. Garcia-Huidobro, M.; Bunster, R.; and Gomez, C.: La Rotura Espontanea del Higado en la Preeclamsia , Rev Chile Obstet Ginec 26:184-188, 1961. 9. Ellis, B.H., and Skoech, T.: Spontaneous Rupture of the Liver After Delivery at Term , J Obstet Gynaec Brit Comm 70:1060-1062, 1963.Crossref 10. Weingold, A.B., and Thompson, J.W.: Spontaneous Rupture of the Liver During Pregnancy , Amer J Obstet Gynec 80:155-160, 1960. 11. Pereyra, A.J., and Lawler, M.P.: Spontaneous Rupture of the Liver in Afibrinogenemia During Pregnancy , Obstet Gynec 7:552-556, 1956. 12. Fezekas, I.G., and Jakobovits, A.: Eclampsia Sine Eclampsia mit Bauchhoehlenverblutung Infolge Leberkapselruptur , Gynaecologia 143:38-47, 1957. 13. DeHaan, Q.C.: Rupture of the Liver Associated With Toxemia of Pregnancy , Amer J Obstet Gynec 93:284-285, 1965. 14. Rodríquez-Erdmann, F.: Intravascular Activation of the Clotting System With Phospholipids: Production of the Generalized Shwartzman Reaction With Platelet Factor 3 , Blood 26:541-553, 1965. 15. Lee, L.: Antigen-Antibody Reaction in the Pathogenesis of Bilateral Renal Cortical Necrosis , J Exp Med 117:365-376, 1963.Crossref 16. McKay, D.G.: Clinical Significance of the Pathology of Toxemia of Pregnancy , Circulation 30 ( (suppl 2) ):66-75, 1964.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Liver Rupture Complicating Toxemia of Pregnancy: An Example of Thrombohemorrhagic Disease

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1967 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1967.00290220125009
Publisher site
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Abstract

Abstract A MULTIPAROUS toxemic postpartum patient sustained a subcapsular hemorrhage of the liver with rupture and shock and survived following a laparotomy. In reviewing the literature on the clinical aspects of 35 cases, we found that this is the sixth patient who survived. A liver biopsy showing hemorrhagic necrosis and periportal fibrin precipitation, and the clinical course and laboratory data presented below suggests that this is an example of disseminated intravascular coagulation as postulated by McKay.1 The role of fibrinolysis as a consequence of coagulopathy was not assessed. The clinical history and findings in the reported cases2-13 have a striking similarity. Hence, a syndrome is recognizable, and a preoperative diagnosis can be made. Given a multipara, usually in her thirties, with toxemia of pregnancy who develops severe pain of the right upper quadrant with vomiting and profound shock, without external blood loss, a diagnosis of subcapsular hemorrhage of the References 1. McKay, D.G.: Disseminated Intravascular Coagulation; an Intermediary Mechanism of Disease , New York: Paul B. Hoeber, Inc, Medical Bk. Dept. of Harper & Row, 1965. 2. Rademaker, L.: Spontaneous Rupture of Liver Complicating Pregnancy , Ann Surg 118:396-401, 1943.Crossref 3. Links, H.: Spontaneous Rupture of the Liver Complicating Pregnancy , Brit Med J 1:275-276 ( (Feb 23) ) 1946.Crossref 4. Burton-Brown, J.R.C., and Shepherd, J.A.: Rupture of the Liver Associated With Parturition , Brit Med J 1:941-943 ( (May 28) ) 1949.Crossref 5. Kramish, D.; Auer, E.S.; and Reckler, S.M.: Spontaneous Rupture of the Liver During Pregnancy , Obstet Gynec 4:21-28, 1954. 6. Baens, A., and Santos-Ocampo, C.C.: Spontaneous Rupture of the Liver in Eclampsia , Phillipp J Surg 14:351-354, 1959. 7. Mahon, R.: La Rupture Spontanée du Foie au Cours de la Grossesse , Rev Franc Gynec Obstet 58:751-764, 1963. 8. Garcia-Huidobro, M.; Bunster, R.; and Gomez, C.: La Rotura Espontanea del Higado en la Preeclamsia , Rev Chile Obstet Ginec 26:184-188, 1961. 9. Ellis, B.H., and Skoech, T.: Spontaneous Rupture of the Liver After Delivery at Term , J Obstet Gynaec Brit Comm 70:1060-1062, 1963.Crossref 10. Weingold, A.B., and Thompson, J.W.: Spontaneous Rupture of the Liver During Pregnancy , Amer J Obstet Gynec 80:155-160, 1960. 11. Pereyra, A.J., and Lawler, M.P.: Spontaneous Rupture of the Liver in Afibrinogenemia During Pregnancy , Obstet Gynec 7:552-556, 1956. 12. Fezekas, I.G., and Jakobovits, A.: Eclampsia Sine Eclampsia mit Bauchhoehlenverblutung Infolge Leberkapselruptur , Gynaecologia 143:38-47, 1957. 13. DeHaan, Q.C.: Rupture of the Liver Associated With Toxemia of Pregnancy , Amer J Obstet Gynec 93:284-285, 1965. 14. Rodríquez-Erdmann, F.: Intravascular Activation of the Clotting System With Phospholipids: Production of the Generalized Shwartzman Reaction With Platelet Factor 3 , Blood 26:541-553, 1965. 15. Lee, L.: Antigen-Antibody Reaction in the Pathogenesis of Bilateral Renal Cortical Necrosis , J Exp Med 117:365-376, 1963.Crossref 16. McKay, D.G.: Clinical Significance of the Pathology of Toxemia of Pregnancy , Circulation 30 ( (suppl 2) ):66-75, 1964.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Apr 1, 1967

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