We report a case of spontaneous liver hemorrhage in a preterm male,
1.4 kg, born in the 32nd week with history of neonatal resuscitation. On day 7
of life, he developed distention of the abdomen. Necrotizing enterocolitis
without perforation was suspected by plain X-ray. C – reactive protein was
negative, white blood count was 39,000/mm
$^{3}$
, platelet
count 309,000/mm
$^{3}$
. On the next day, further deterioration
was observed and patient developed pneumoperitonium. On exploration, soon after
opening abdomen, before putting in any retractors, sudden bleeding started from
liver surface without iatrogenic trauma. The patient became hemodynamically
unstable and received crystalloids and blood. Bleeding control was attempted by
packing and pressing the liver surface, but could not be stopped and baby
succumbed intraoperatively. The purpose of our case report is to emphasize that
massive liver hemorrhage during or after laparotomy remains a rare but serious
complication in the course of perforated necrotizing enterocolitis in very low
birth weight infants. The key to patient survival is knowledge about the
possibility of such a problem during surgical intervention and avoidance of
invasive operative procedures to control bleeding.
