title: Aetio-pathogenesis and the management of spontaneous liver bleeding in the West: a 16-year single-centre experience.
abstract: BACKGROUND
  Spontaneous liver bleeding (SLB) is a rare but potentially fatal complication. In contrast to the East, various benign pathologies are the source of SLB in the West. An accurate diagnosis and a timely implementation of appropriate treatment are crucial in the management of these patients. The present study presents a large Western experience of SLB from a specialist liver centre.
  
  
  METHODS
  A retrospective analysis of patients presented with SLB between January 1995 and January 2011.
  
  
  RESULTS
  Sixty-seven patients had SLB, 44 (66%) were female and the median age at presentation was 47 years. Abrupt onset upper abdominal pain was the presenting symptom in 65 (97%) patients. The aetiology for SLB was hepatic adenoma in 27 (40%), hepatocellular carcinoma (HCC) in 17 (25%) and various other liver pathologies in the rest. Emergency treatment included a conservative approach in 42 (64%), DSA and embolization in 6 (9%), a laparotomy and packing in 6 (9%) and a liver resection in 11 (16%) patients. Eleven (16%) patients had further planned treatments. Seven (10%) died during the same admission but the mortality was highest in patients with HELLP syndrome. At a median follow-up of 54 months all patients with benign disease are alive. The 1-, 3- and 5-year survival of patients with HCC was 59%, 35% and 17%, respectively.
  
  
  CONCLUSIONS
  SLB is a life-threatening complication of various underlying conditions and may represent their first manifestation. The management should include initial haemostasis followed by appropriate staging investigations to provide a definitive treatment for each individual patient.
authors.affiliation: Liver unit, Queen Elizabeth Hospital, Birmingham, UK. docnaren@hotmail.com
authors.forename: Narendra
authors.initials: N
authors.lastname: Battula
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsapralis
authors.forename: Arjun
authors.initials: A
authors.lastname: Takhar
authors.forename: Chris
authors.initials: C
authors.lastname: Coldham
authors.forename: David
authors.initials: D
authors.lastname: Mayer
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D018248:Adenoma, Liver Cell / Q000150:complications / Q000628:therapy; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy; D003560:Cysts / Q000150:complications / Q000628:therapy; D004621:Embolization, Therapeutic; D004739:England; D005260:Female; D017359:HELLP Syndrome / Q000628:therapy; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006489:Hemostatic Techniques; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult