976 Traumatic Damage to The Liver Capsule: An Unusual Cause of Small Bowel Obstruction

A 57-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side whilst cycling but had not sought medical attention. On admission, a CT scan showed small bowel obstruction and he underwent an emergency laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. Small bowel obstruction is a common presentation in A&E and is responsible for half of emergency laparotomies in the UK each year. Although hepatic haematomas are also a relatively common complication of blunt trauma to the abdomen, associated bowel herniation into the liver capsule is very unusual. We believe this is the first time such a case of small bowel obstruction has been reported in the literature and we discuss details of operative management and highlight key learning points.

Mimicker of Fitz-Hugh-Curtis syndrome: A case report of perihepatitis secondary to sigmoid colonic perforation

Perihepatitis is an uncommon condition defined as the inflammation of the peritoneal liver capsule. It is more commonly known as Fitz-Hugh-Curtis syndrome, a rare condition characterized by the inflammation of the peritoneum and tissue around the liver. This syndrome is usually associated with pelvic inflammatory disease (PID). However, PID is not always the cause of perihepatitis. We reported a rare case of perihepatitis which occurs secondarily to sigmoid colonic perforation.

Traumatic damage to the liver capsule: an unusual cause of small bowel obstruction

A 61-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side while cycling, but had not sought medical attention. On admission, a CT scan showed small bowel obstruction (SBO) and he underwent an emergency open laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. We believe this is the first reported case of SBO secondary to small bowel herniation into the liver capsule following trauma.

Percutaneous solutions for biliary stent dysfunction: pictorial essay

Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

ECHOGRAPHIC CHARACTERISTICS OF THE SURFACE STRUCTURES OF THE LIVER IN CHRONIC FORMS OF ORGAN PATHOLOGY IN CHILDREN

Chronic liver disease (CLD) is characterized by a progressive course, the formation of fibrosis and cirrhosis. Existing echographic criteria for assessing pathological changes fail to allow to determine accurately the severity of fibrosis, and sometimes, cirrhosis. A liver biopsy carries the risk of non-informative biopsies and the development of complications. In this regard, additional diagnostic criteria are needed to judge the state of the liver tissue, in particular, its surface structures, in both cases without liver involvement and CLD patients. Materials and methods. 75 CLD patients were included in the main group and 73 children without liver pathology - in the control group. An ultrasound system of the expert class was used to perform an echographic assessment of the surface structures of the liver: the thickness of the Glisson’s capsule, the presence of its stratification and nodularity, increased subcapsular blood flow, and the shape of the edge of the liver. In order to assess the severity of pathological changes, all patients of the main group underwent an edge biopsy of the liver under laparoscopic control, followed by histological examination of biopsy specimens. The obtained ultrasound data in CLD patients were compared with the results of a morphological study. Fibrosis stages were calculated using the METAVIR scale. Results. The thickness of the liver capsule in patients of the main group was found to be significantly greater than in the control group (p = 0.000). The degree of thickening of the surface structures in CLD patients increases significantly with the age when compared with healthy children. Significant differences were found in the incidence of stratification and heterogeneity of the surface structures of the liver in CLD children. The presence of echographic changes in the liver capsule was detected in 29 out of the 75 patients of the main group. In these patients, rounding of the edge of the liver was often noted - 27 cases and stratification of the surface structures - 26 cases. Changes in the surface structures of the liver were detected primarily in patients with cirrhosis (stage F4). Stratification of the surface structures of the liver was often noted in them, and capsule heterogeneity and asynchronous movement of the capsule and visceral peritoneum were detected in more than half of cases among all echographic changes in CLD children. Conclusion The echographic heterogeneity of the liver capsule and the asynchronous movements of the capsule and visceral peritoneum in CLD children are informative criteria for organ pathology and can be used for diagnosis.

ULTRASONIC CHARACTERISTICS OF THE STRUCTURE OF THE LIVER CAPSULE IN HEALTHY CHILDREN OF DIFFERENT AGES

Ultrasound examination (ultrasound) takes the first place first among visual methods for analyzing the state of the liver parenchyma. Despite the improvement of ultrasound technology, it does not provide the necessary diagnostic accuracy in determining the stages of liver fibrosis. In this regard, it is necessary to search for additional diagnostic criteria to judge the state of the liver tissue and its superficial structures, primarily liver capsules.Materials and methods: the state of the liver capsule was assessed in 73 children of four age groups (2-18 years) without pathological changes in the hepatobiliary system, which were performed by ultrasound of the abdominal organs during preventive examinations. The structure of the capsule of the liver and visceral peritoneum was evaluated. Results. Direct dependence of the thickness of the liver capsule on the age of children was established (rs = 0.577, p = 0.0000). The capsule and visceral peritoneum represented a single and even echogenic structure (95.9%). Stratification of the leaves was detected in 8 children. A change in the shape of the edge of the right lobe of the liver was observed in 4 children. An increase in the severity of subcapsular blood flow in the liver was not detected in any healthy child.