A 72 y.o. with a known AAA presents with severe abd and back pain
What did she die of?
Our patient had a spontaneous hepatic rupture. Although she had a history of aneurysms, none were ruptured on the CT scan.
Spontaneous hepatic rupture isa rare condition associated with a high mortality rate. Spontaneous hepatic rupture has been associated with liver disease: specifically HELLP syndrome, amyloidosis, hypereosinophilic syndrome and connective tissue disease.
Hepatic causes- rupture of a tumor specifically adenomas in young women on birth control, HELLP syndrome
Splenic causes- occurs with marked splenomegalyin CVM, mono, or hematologic malignancies
Renal causes- renal tumor such as angiomyolipoma or vasculitis
Adrenal causes- spontaneous hemorrhage in septic shock.
Vascular causes-AAA
Gynecologic causes- ruptured ovarian cyst, ectopic pregnancy or bleeding fibroid.
This image is from a 37 y.o. woman who presented in shock to room 11. She was thought to be using K2 by ems as they found her unresponsive in the bathroom of a store. She was in hemorrhagic shock from a bleeding fibroid and had an emergent hysterectomy.
Spontaneous intraperitoneal hemorrhage has many causes—fortunately most of them are rare.
Teaching point: beware the pt presenting in shock; it is not always sepsis. Consider bleeding causes.
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