LIVER RUPTURE AFTER CARDIOPULMONARY-RESUSCITATION IN A PATIENT RECEIVING THROMBOLYTIC THERAPY

A patient with an acute myocardial infarction had to be resuscitated d ue to recurring ventricular fibrillation. After stabilisation, she rec eived thrombolytic treatment with anistreplase. Fourteen hours later, clinical signs of hemoperitoneum developed and the diagnosis of liver rupture was made. After abdominal surgery and coronary revascularisati on, the subsequent clinical course was uncomplicated. The literature o n liver trauma after CPR as well as thrombolysis in association with C PR is reviewed. This observation suggests that there are no convincing arguments to withhold thrombolytic therapy in acute myocardial infarc tion after CPR in the absence of gross trauma. We stress that a high d egree of clinical alertness is necessary to diagnose this life-threate ning condition because of its frequent subacute evolution in patients that are per se hemodynamically unstable.