• Fabio Giannone, Lorenzo Cinelli, Arielle Bellissard, Zineb Cherkaoui, Emanuele Felli, Antonio Saviano, Pierre Mayer, and Patrick Pessaux.
• Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, 67100, Strasbourg, France. giannone.cf@gmail.com.
• Eur J Trauma Emerg Surg. 2024 Mar 19.

BackgroundSpontaneous idiopathic liver hemorrhage (SILH) is a rare life-threatening condition occurring without a clear and specific etiology. A systematic review was performed to provide guidelines for the perioperative management of patients affected by SILH. A case report was also included.MethodsA systematic search of the last 24-year literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines.ResultsAfter an initial selection of 6995 titles, 15 articles were considered for the final qualitative analysis (n = 22 patients, including the present report). Conservative treatment was chosen in 12 cases (54.5%) with stable clinical conditions, while 9 patients (40.9%) required a primary operative approach for emergency presentation at diagnosis. Direct liver resection was the preferred surgical treatment (n = 6), mostly major hepatectomies (n = 4). Hepatic arterial embolization was performed as the primary operative approach in three patients, followed by emergency laparotomy during the same hospitalization because of rebleeding in one case. Contrast-enhanced CT scan was the gold standard for diagnosis (n = 19).ConclusionsConservative treatment of SILH is mainly based on stable clinical conditions and may be considered even in case of a limited arterial blush found on imaging. The absence of underlying hepatic or systemic disorders seems to correlate with favorable outcomes and no mortality.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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