5

docx

School

Kenyatta University *

*We aren’t endorsed by this school

Course

Subject

Medicine

Date

Nov 24, 2024

Type

docx

Pages

Uploaded by muchiribenson75

Title Liver Perforation Injury During Liposuction Authors 1. Plastic and Reconstructive Surgery Department, Hamad Medical Corporation, Doha, Qatar Abstract Introduction: Liposuction is known to be a safe medical procedure. However, rare complications can occur postoperatively. Iatrogenic liver perforation post liposuction is a very rare and serious complication which requires immediate medical intervention. Case presentation: We report a case of a 42-year-old female patient who underwent liposuction and sustained iatrogenic liver perforation as a complication. The laboratory findings and imaging studies indicated an active bile leak lateral to right liver lobe. She presented with subscapular hematoma of 5% and >2 centimeter laceration and was diagnosed with grade one liver injury. Conclusion: Despite liposuction being generally considered as a safe medical procedure, it can lead to life threatening complications such as hollow viscus or solid organ injury. The treatment can be surgical or non-surgical depending on the diagnosis. A high index of patient suspicion is needed to promptly detect and manage emerging rare complications. Introduction Liposuction is a widely popular cosmetic surgery that involves the removal of excess body fat through suction cannulas. Although it is generally considered a safe procedure, like any surgical intervention, liposuction is not without risks and complications. Contour irregularities, fluid

accumulation, and pulmonary embolism are some of the common liposuction-related complications (Conkbayir 876). Liver perforation and spleen injuries are rare complications of the procedure. The incidence of iatrogenic liver perforation following liposuction is estimated to be very low, ranging from 0.02% to 0.09%, according to various studies (Harnett 203). While it is a rare complication of liposuction, it can be life-threatening and may require immediate medical attention. We report this case to provide an overview of the incidence, risk factors, and management of iatrogenic liver perforation as a rare complication of liposuction. This case report aims to shed some light on iatrogenic liver injury during abdominal wall liposuction, which should help in prompt diagnosis and management of this life threatening complication Case Presentation A 42-year-old female presented to our emergency department with abdominal pain and generalized body weakness three days after she had a revision Suction Assisted Abdomino- dermolipectomy (SADL) with buttock lipo-filling and black dermolipectomy in a private hospital. The patient had a history of sleeve gastrectomy in 2015, laparoscopic cholecystectomy in 2016 and history of abdominoplasty, brachioplasty and thigh lift in 2016. She has no co- morbidities and was not taking any medications regularly. A physical examination revealed severe diffuse tenderness in the abdomen mainly in the left and right flanks with rigidity. Her laboratory results were remarkable for an elevated alkaline phosphatase and slightly elevated liver enzymes, in addition to an elevated c-reactive protein of 200. Her hemoglobin was 10.2, and white blood cell count was within normal. The MRI and CT scan reports showed that she had active bile leak lateral to right liver lobe (hepatic segment 6) extending to the sub hepatic region as well as a focal narrowing of the proximal CBD near cholecystectomy clips while the

endoscopic retrograde cholangiopancreatography scan revealed delayed passage of contrast into distal CBD. The patient had a mild intrahepatic biliary tree dilatation was also noted. The patient did not have definite active contrast extravasation to suggest active bleed (Figures 1, 2). Our patient was admitted to the hospital and underwent exploratory laparotomy with peritoneal lavage. Intraoperatively, a penetrating injury to the lateral surface of the right lobe of the liver with active bile leak from site of the penetrated area was detected. About 3 liters of intraabdominal clear bile was drained, mainly in the right paracolic gutter, left paracolic gutter and pelvis. The small bowel, large bowel, and other abdominal organs were intact. The small size of subcapsular hematom, angiographic intervention or surgery were not necessary during hospitalization. Discussion Complications related to liposuction are on the rise (Taha and Tahseen 1). Some of these complications include thromboembolism, fat embolism, sepsis, and lidocaine toxicity (Pohlan et al. 909). Fat embolism is a relatively common complication after liposuction procedure with between 20% and 40% of mortality rates (Ahmed 3). Common sites for such perforations include the small bowel, colon, and spleen. They comprise more than 15% of complications related to liposuction. Iatrogenic liver perforation post liposuction is a serious complication which poses an immediate life threatening risk (Pohlan et al. 906). Normally, liposuction is Routinely performed by inserting a suction cannula through a small stab incision. After entering the desired subcutaneous plane, repetitive back and forth strokes are initiated to facilitated suction of the fat from the desired region (Gialamas et al. 212). There are several factors that may increase the risk of iatrogenic liver perforation during liposuction, including a wrong trajectory when performing the

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

back and forth liposuction (Pohlan et al. 908). Adhering to the high operation standards in essential to mitigate the risks. A high index of suspicion is needed to detect any solid or hollow organ injury post abdominal wall liposuction. Close monitoring of all patients undergoing liposuction should be done for the first two post-operative hours (You et al.). The common signs that can be helpful in detecting liver perforations include severe abdominal pain, fever, and low blood pressure (Lu et al.). A patient should seek medical attention immediately upon noticing such symptoms (Table 1). CT scans are used to establish an accurate diagnosis (Liu et al.). Contrast-enhanced ultrasound (CEUS) has been proved to be the preferred tool for monitoring of penetrating liver injury. It is a minimally invasive tool that is less toxic to the renal tubules and has high sensitivity for detecting penetrating organ injury. Early diagnosis and prompt management are crucial to reducing the morbidity and mortality associated with iatrogenic liver perforation. Pohlan tet al. reiterates that it is important to grade the severity of liver injury based on the criteria provided by the American Association of Surgery for Trauma, adding that diagnosis based on this procedure facilitates effective to targeted surgical or nonsurgical treatment (909). Minor injuries may be managed conservatively with observation and supportive care, while more severe injuries may require angioembolization or surgical intervention (Pohlan et al. 909). It is always wise to involve a hepato-biliary surgeon early on in the management of such injuries. Conclusion Iatrogenic liver perforation is a rare but potentially life-threatening complication of liposuction. High index of suspicion, early diagnosis and prompt management are crucial to achieving the

best possible outcome for patients who experience iatrogenic liver perforation following liposuction. Surgeons should be aware of this potential complication and take appropriate precautions to minimize the risk of injury to the liver during liposuction procedures. Disclosures There are no potential conflicts of interest with respect to this research, publication of the article, and authorship. Funding There was no financial support received for conducting this research, authorship, and publication of the article.

References 1. Ahmed, Mohamed Badie, et al. “Necrotizing Soft Tissue Infection Post Vaser-Assisted Liposuction and Lipofilling: A Case Report.” Aesthetic Surgery Journal Open Forum , vol. 5, 2023, https://doi.org/10.1093/asjof/ojad013. 2. Bartow, Matthew, and Blake Raggio. Liposuction - Statpearls - NCBI Bookshelf, 2023, www.ncbi.nlm.nih.gov/books/NBK563135/. 3. Conkbayir, Cenk. "Massive Pulmonary Thromboembolism After Abdominoplasty and Liposuction." Liposuction , 2016, pp. 875-877. 4. Doumit, Gaby, and Mihiran Karunanayake. "Fat Embolism After Liposuction in Klippel- Trenaunay Syndrome." Liposuction , 2016, pp. 867-873. 5. Gialamas, Eleftherios, et al. "Liver Trauma During Combined Liposuction and Abdominoplasty: A Rare but Potentially Lethal Complication." Aesthetic Surgery Journal , vol. 35, no. 7, 2015, pp. NP211-NP215. 6. Harnett, Paul, et al. "Splenic trauma during abdominal wall liposuction: a case report." Journal of the Royal Society of Medicine , vol. 101, no. 4, 2008, pp. 201-203. 7. Kao, Yu-Ming, et al. “Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases.” Healthcare, vol. 11, no. 10, 2023, p. 1391, https://doi.org/10.3390/healthcare11101391. 8. Liu, Zhiwan, et al. "Toxic shock syndrome complicated with symmetrical peripheral gangrene after liposuction and fat transfer: a case report and literature review." BMC Infectious Diseases , vol. 21, no. 1, 2021. 9. Lu, Jinqiang, et al. "Infectious shock after liposuction." BMC Infectious Diseases , vol. 22, no. 1, 2022. 10. Pohlan, Julian, et al. "Multiple liver perforations: complication of an outpatient liposuction procedure." Radiology Case Reports , vol. 16, no. 4, 2021, pp. 906-910. 11. Shiffman, Melvin A., and Alberto D. Giuseppe. Liposuction: Principles and Practice . Springer, 2016. 12. Robb, Chris, and Michael H. Gold. "Complications and Solutions for Post-Operative Liposuction Deformities." Enhanced Liposuction - New Perspectives and Techniques , 2022. 13. Taha, A. A., & Tahseen, H. (2020). Spreading awareness: bowel perforation with liposuction. Plastic and Reconstructive Surgery –Global Open, 8(3), e2715. DOI: 10.1097/GOX.0000000000002715 14. You, Je S., et al. "Imaging Findings of Liposuction with an Emphasis on Postsurgical Complications." Korean Journal of Radiology , vol. 16, no. 6, 2015, p. 1197.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Figures

Tables Table Showing symptoms of some Liposuction related complications (Mathew and Blake; Kao et al. 6) Liposuction Related Complications Symptoms Liver Injury ● Active bile leak lateral to right liver lobe ● focal narrowing of proximal CBD near cholecystectomy clips with delayed passage of contrast into distal CBD ● Pain ● Distension ● Nausea ● Vomiting Non-mechnaical obstruction Swelling of the abdomen Vomiting Crampy Abdominal pain Swelling

5

Related Documents