Hemoretroperitoneum associated with liver bare area injuries: CT evaluation

Area of Science:

• Radiology
• Trauma Surgery
• Hepatobiliary Medicine

Background:

• Hepatic injuries, particularly in the bare area of segment VII, may present without hemoperitoneum.
• This specific injury pattern can be associated with hemoretroperitoneum, complicating diagnosis.
• Absence of peritoneal signs and negative imaging can lead to underestimation of injury severity.

Purpose of the Study:

• To investigate the association between bare area liver injuries and hemoretroperitoneum.
• To evaluate the role of Computed Tomography (CT) in identifying these injuries and associated hemorrhage.

Main Methods:

• Retrospective review of CT examinations in 32 patients with blunt liver trauma.
• Analysis of lesion location, focusing on the bare area of segment VII.
• Correlation of lesion characteristics with the presence of hemoperitoneum and hemoretroperitoneum.

Main Results:

• 44 parenchymal lesions were identified in 32 patients.
• Segment VII was involved in 16 cases, with 8 lesions specifically in the bare area.
• In segment VII lesions, hemoperitoneum was detected in 3 cases, hemoretroperitoneum in 4, and both in 4.
• Bare area injuries were associated with hemoretroperitoneum more frequently than hemoperitoneum.

Conclusions:

• Traumatic hepatic lesions in the bare area are often associated with hemoretroperitoneum.
• CT is essential for accurate detection and localization of both parenchymal damage and hemorrhage (intraperitoneal and retroperitoneal).
• Relying solely on peritoneal lavage or ultrasound may lead to misdiagnosis and inadequate management of these injuries.