Non-traumatic liver rupture due to a perforated gastric ulcer

The case of a 57-year-old woman with a fatal liver rupture due to a necrotizing perihepatic abscess caused by a perforated gastric ulcer is presented. The ulcer had been treated successfully by surgical intervention 8 days before. The autopsy revealed a large perihepatic abscess and multiple ruptures of Glisson's capsule with a large subcapsular hematoma and underlying lacerations of the liver parenchyma. The patient had no history of previous abdominal trauma and the known etiological factors for spontaneous liver rupture were excluded by the autopsy findings or by clinical and laboratory data. No liver penetration by the gastric ulcer was found at autopsy and there were no clinical signs or symptoms for an infection or any degenerative or inflammatory diseases. Histologically abundant vegetable fibers, identified as stomach contents and a dense infiltrate of lymphocytes and granulocytes were found in the perihepatic abscess next to Glisson's capsule. Below Glisson's capsule there were hemorrhages, focal hepatocellular necrosis and a mixed cell inflammatory infiltration. In the present case, preceding perforation of the gastric ulcer with leaking of gastric acid into the peritoneal cavity resulted in peptic digestion of Glisson's capsule. Vascular lesions of the affected parts of Glisson's capsule and the liver parenchyma underneath resulted in intrahepatic hemorrhage and an increase in intrahepatic pressure with subsequent liver rupture. To the authors' knowledge no similar case of spontaneous liver rupture due to perforation of a gastric ulcer has been reported previously.