title: Hepatic tear as an elusive cause of hemoperitoneum complicating cardiac surgery.
abstract: We report an unusual source of intra-operative bleeding in a patient undergoing cardiosurgical reoperation. After sternotomy, hematocrit dropped significantly. Only intra-thoracic bleeding from adhesions was considered to be responsible for the anemia. During reperfusion, abdominal wall was distended with a bluish bulge in the right hemidiaphragm. Immediate laparotomy revealed bleeding from a tear in the right hepatic lobe without any diaphragm injury. The tear was likely caused by blunt trauma from an oscillating saw. We emphasize cautious use of an oscillating saw in patients with hepatic congestion undergoing a repeat sternotomy. We propose that lifting the sternum in redo procedures might prevent the hepatic tear.
authors.affiliation: Department of Anaesthesia, Resuscitation and Intensive Care, General University Hospital, 1st School of Medicine, Charles University, U Nemocnice 2, 128 00, Prague 2, Czech Republic. jan.kunstyr@post.cz
authors.forename: Jan
authors.initials: J
authors.lastname: Kunstyr
authors.forename: Jan
authors.initials: J
authors.lastname: Tosovsky
authors.forename: Josef
authors.initials: J
authors.lastname: Korinek
authors.forename: Martin
authors.initials: M
authors.lastname: Stritesky
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D005260:Female; D006400:Hematocrit; D006465:Hemoperitoneum / Q000097:blood / Q000209:etiology* / Q000628:therapy; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000293:injuries*; D008875:Middle Aged; D012086:Reoperation; D013249:Sternum / Q000601:surgery*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000150:complications* / Q000209:etiology / Q000601:surgery
chemical_list: D006490:Hemostatics