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.

Ades CJ, Strutton GM, Walker NI,Furnival CM and Whiting G.Spontaneous rupture of the liver associated with amyloidosis. Journal of Clinical Gastroenterology, 1989  11(1), 85-7.

Andersson R, Tranberg KG, BengmarkS. Hemoperitoneum after spontaneous rupture of liver tumor: results of surgical treatment. HPB Surgery, 1988 1(1), 81-83.

Smith LG, Moise KJ, Dildy GA, Carpenter RJ. Spontaneous rupture of the liver during pregnancy: current therapy. Obstetrics and Gynecology, 1991, 77(2), 171-175.

Cozzi PJ, Morris DL. Two cases of spontaneous liver rupture and literature review, HPB Surgery, 1996, 9(4), 257-260.

Gurlan A, Fakhran S, Federle M. Spontaneous Abdominal Hemorrhage: Causes, CT findings, and Clinical Implications. 2009. AJR. 193(4) 1077-1087.