Portal de Periódicos da CAPES

Hepatic tear as an elusive cause of hemoperitoneum complicating cardiac surgery

2008; Oxford University Press; Volume: 7; Issue: 3 Linguagem: Inglês

10.1510/icvts.2007.173757

1569-9293

Jan Kunstýř, J Tosovský, Josef Kořínek, Martin Stříteský,

Congenital Diaphragmatic Hernia Studies

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.