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April 1967

Liver Rupture Complicating Toxemia of Pregnancy: An Example of Thrombohemorrhagic Disease

Author Affiliations

Middletown, NY

From the departments of medicine (Dr. Mokotoff), obstetrics (Drs. Weiss and Brandon), and surgery (Dr. Camillo), Elizabeth A. Horton Memorial Hospital, Middletown.

Arch Intern Med. 1967;119(4):375-380. doi:10.1001/archinte.1967.00290220125009

A MULTIPAROUS toxemic postpartum patient sustained a subcapsular hemorrhage of the liver with rupture and shock and survived following a laparotomy. In reviewing the literature on the clinical aspects of 35 cases, we found that this is the sixth patient who survived. A liver biopsy showing hemorrhagic necrosis and periportal fibrin precipitation, and the clinical course and laboratory data presented below suggests that this is an example of disseminated intravascular coagulation as postulated by McKay.1 The role of fibrinolysis as a consequence of coagulopathy was not assessed.

The clinical history and findings in the reported cases2-13 have a striking similarity. Hence, a syndrome is recognizable, and a preoperative diagnosis can be made. Given a multipara, usually in her thirties, with toxemia of pregnancy who develops severe pain of the right upper quadrant with vomiting and profound shock, without external blood loss, a diagnosis of subcapsular hemorrhage of the

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