title: Laparoscopic cholecystectomy associated lethal hemorrhage.
abstract: OBJECTIVE
  Blood oozing after cholecystectomy is a rare but potentially life-threatening complication. Recently, 2 patients died from this cause. The deaths resulted in criminal proceedings and medical experts were called in. The objective of this report is to describe their findings and to elucidate preoperatively unknown risk factors of bleeding.
  
  
  METHODS
  Medical records, autopsy, and histological examination of the liver, heart, pancreas, spleen, and kidney pertaining to 2 recent cases of laparoscopic cholecystectomy were examined. Current literature on this topic was reviewed.
  
  
  RESULTS
  Preoperative risks included renal insufficiency, diabetes mellitus, and cardiopathy. The histological examination, in particular of the gallbladder bed of the liver, disclosed siderosis, inflammation, and fatty degeneration. These factors supported and perpetuated blood oozing. Postoperative ultrasonography and a hemogram might have detected and prevented death.
  
  
  CONCLUSIONS
  Inflammatory alterations, siderosis, and fatty degeneration of the liver are risk factors of postoperative hemorrhage. Autopsy and histological examination can detect those factors. Adequate postsurgical observation is mandatory, especially for patients at risk.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Ulm, Ulm, Germany. klaus.buttenschoen@uniklinik-ulm.de
authors.forename: Klaus
authors.initials: K
authors.lastname: Buttenschoen
authors.forename: Michael
authors.initials: M
authors.lastname: Tsokos
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schulz
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D017809:Fatal Outcome; D005704:Gallbladder / Q000098:blood supply / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012307:Risk Factors