Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 18, 2016; 8(32): 1414-1418
Published online Nov 18, 2016. doi: 10.4254/wjh.v8.i32.1414
Spontaneous liver rupture as first sign of polyarteritis nodosa
Irene Gómez-Luque, Felipe Alconchel, Rubén Ciria, M Dolores Ayllón, Antonio Luque, Marina Sánchez, Pedro López-Cillero, Javier Briceño
Irene Gómez-Luque, General Surgery, Reina Sofía University Hospital, 14004 Córdoba, Spain
Felipe Alconchel, Department of Surgery, Faculty of Medicine and Nursing, University of Córdoba, 14071 Córdoba, Spain
Rubén Ciria, M Dolores Ayllón, Antonio Luque, Pedro López-Cillero, Javier Briceño, Unit of Hepatobiliary Surgery and Liver Transplant, Reina Sofía University Hospital, 14004 Córdoba, Spain
Marina Sánchez, Department of Pathology, Reina Sofía University Hospital, 14004 Córdoba, Spain
Author contributions: Gómez-Luque I and Alconchel F contributed equally to this work; Ciria R, López-Cillero P and Briceño J designed the research; Gómez-Luque I, Alconchel F, Ayllón MD and Luque A performed the research; Sánchez M performed the pathological analyses; Gómez-Luque I, Alconchel F and Ayllón MD wrote the paper.
Institutional review board statement: The following manuscript is in accordance with the ethics standards in our Hospital. It has been reviewed and approved by all the authors and by the Institute of Biomedical Research of Cordoba (IMIBIC).
Informed consent statement: The following manuscript has been written and produced after full approval form the patient, who, in the informed consent, gave the authorization to use the data and images derived from his clinical condition.
Conflict-of-interest statement: Authors declare have no conflicts of interest. The present study did not receive any financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Rubén Ciria, MD, PhD, Unit of Hepatobiliary Surgery and Liver Transplant, Reina Sofía University Hospital, Avda, Menéndez Pidal s/n, 14004 Córdoba, Spain.
Telephone: +34-600-890079 Fax: +34-95-7010949
Received: March 1, 2016
Peer-review started: March 2, 2016
First decision: March 22, 2016
Revised: September 13, 2016
Accepted: October 5, 2016
Article in press: October 9, 2016
Published online: November 18, 2016

Polyarteritis nodosa (PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.

Keywords: Polyarteritis nodosa, Spontaneous liver rupture, Liver surgery, Vasculitis, Rheumatology

Core tip: Spontaneous liver rupture is a rare entity with very few cases in the literature reviewed; even when it has an autoimmune disease such etiology and with no previous trauma. We present our experience managing an urgent abdominal hemorrhage caused by a liver rupture as a first manifestation of Polyarteritis in a 75-year-old woman.