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Case report
Spontaneous hepatic rupture due to primary amyloidosis
  1. Shravan Leonard-Murali,
  2. Hassan Nasser,
  3. Tommy Ivanics and
  4. Ann Woodward
  1. Surgery, Henry Ford Hospital, Detroit, Michigan, USA
  1. Correspondence to Dr Shravan Leonard-Murali; smurali1{at}hfhs.org

Abstract

Spontaneous hepatic rupture is an uncommon cause of haemorrhagic shock and very rarely happens due to amyloidosis. This report describes one such case in which a middle-aged man presented in extremis. He was managed initially with massive transfusion, interventional radiology embolisation and decompressive laparotomy for abdominal compartment syndrome. Subsequent coagulopathy was treated with activated factor VII due to deficient native activity. Serum protein electrophoresis and liver biopsy during his hospital course yielded a diagnosis of amyloidosis, which was treated palliatively with steroids and bortezomib. Despite supportive care, he died 10 days after presentation. This case illustrates the importance of considering an uncommon pathology when a patient presents with a condition in an uncommon way.

  • haematology (incl blood transfusion)
  • general surgery
  • interventional radiology
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Footnotes

  • Contributors SL-M and HN took direct care of the patient described in the case report submitted. SL-M wrote the case report and did background research. HN and TI provided editing and creative input during the entire process. AW provided senior counsel and overarching edits.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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