Cardiopulmonary Resuscitation-Induced Right Hepatic Lobe Laceration Causing Delayed 5,500-ML Hemoperitoneum During Post-resuscitation Anticoagulation: A Case Report

Closed-chest cardiopulmonary resuscitation (CPR) can induce rare, life-threatening intra-abdominal visceral injuries.We report a case of CPR-induced liver laceration leading to delayed massive intraabdominal hemorrhage (5,500 mL) in a 40-year-old male patient with acute coronary syndrome (ACS) due to severe left main coronary artery (LMCA) stenosis.Following the return of spontaneous circulation (ROSC) achieved 32 minutes after collapse (28 minutes of CPR), the patient was managed with an intra-aortic balloon pump (IABP), systemic unfractionated heparin, and targeted temperature management (TTM at 34°C).On post-resuscitation day 2 during rewarming, the patient developed delayed hemorrhagic shock and marked abdominal distension, with hemoglobin plunging from 16.3 g/dL to 7.5 g/dL.Dynamic contrastenhanced computed tomography (CT) demonstrated massive hemoperitoneum without active arterial extravasation (blush).Following emergent blood transfusion and volume resuscitation, exploratory laparotomy evacuated 5,500 mL of dark blood and identified a deep capsule laceration on the visceral surface of the right hepatic lobe adjacent to the gallbladder attachment site with continuous venous oozing.Direct parenchymal suturing, cholecystectomy, and topical application of human fibrinogen/thrombincoated collagen fleece (TachoComb) achieved complete hemostasis.The patient was successfully weaned from IABP on postoperative day 1 and transferred for elective coronary artery bypass graft surgery (CABG) with complete neurological recovery (Cerebral Performance Category 1).In post-resuscitation patients under systemic anticoagulation and suspected hypothermia-associated coagulopathy, delayed shock must immediately raise suspicion of visceral trauma.The absence of arterial blush on dynamic CT does not exclude life-threatening venous oozing, and prompt open laparotomy with direct mechanical hemostasis represents a life-saving intervention.