• Narendra Battula, Dimitrios Tsapralis, Arjun Takhar, Chris Coldham, David Mayer, John Isaac, Paolo Muiesan, Robert P Sutcliffe, Ravi Marudanayagam, Darius F Mirza, and Simon R Bramhall.
• Liver unit, Queen Elizabeth Hospital, Birmingham, UK. docnaren@hotmail.com
• HPB (Oxford). 2012 Jun 1;14(6):382-9.

BackgroundSpontaneous liver bleeding (SLB) is a rare but potentially fatal complication. In contrast to the East, various benign pathologies are the source of SLB in the West. An accurate diagnosis and a timely implementation of appropriate treatment are crucial in the management of these patients. The present study presents a large Western experience of SLB from a specialist liver centre.MethodsA retrospective analysis of patients presented with SLB between January 1995 and January 2011.ResultsSixty-seven patients had SLB, 44 (66%) were female and the median age at presentation was 47 years. Abrupt onset upper abdominal pain was the presenting symptom in 65 (97%) patients. The aetiology for SLB was hepatic adenoma in 27 (40%), hepatocellular carcinoma (HCC) in 17 (25%) and various other liver pathologies in the rest. Emergency treatment included a conservative approach in 42 (64%), DSA and embolization in 6 (9%), a laparotomy and packing in 6 (9%) and a liver resection in 11 (16%) patients. Eleven (16%) patients had further planned treatments. Seven (10%) died during the same admission but the mortality was highest in patients with HELLP syndrome. At a median follow-up of 54 months all patients with benign disease are alive. The 1-, 3- and 5-year survival of patients with HCC was 59%, 35% and 17%, respectively.ConclusionSLB is a life-threatening complication of various underlying conditions and may represent their first manifestation. The management should include initial haemostasis followed by appropriate staging investigations to provide a definitive treatment for each individual patient.© 2012 International Hepato-Pancreato-Biliary Association.

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