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 necroti zing perihepatic abscess caused by a perforated gastric ulcer is presented. The ulcer had been treated successfully by surgical intervention 8 days be fore. The autopsy revealed a large perihepatic abscess and multiple rupture s of Glisson's capsule with a large subcapsular hematoma and underlying lac erations of the liver parenchyma. The patient had no history of previous ab dominal trauma and the known etiological factors for spontaneous liver rupt ure were excluded by the autopsy findings or by clinical and laboratory dat a. 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, identifie d as stomach contents and a dense infiltrate of lymphocytes and granulocyte s were found in the perihepatic abscess next to Glisson's capsule. Below Gl isson's capsule there were hemorrhages, focal hepatocellular necrosis and a mixed cell inflammatory infiltration. In the present case, preceding perfo ration of the gastric ulcer with leaking of gastric acid into the peritonea l cavity resulted in peptic digestion of Glisson's capsule. Vascular lesion s of the affected parts of Glisson's capsule and the liver parenchyma under neath resulted in intrahepatic hemorrhage and an increase in intrahepatic p ressure with subsequent liver rupture. To the authors' knowledge no similar case of spontaneous liver rupture due to perforation of a gastric ulcer ha s been reported previously.