PMC6016175_01
Ecchymosis on calves developed as one of the signs of DIC after uncontrollable PPH.
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Signs of DIC developed with continuous blood loss (Figure 1), and her consciousness deteriorated within 30 minutes after arriving at the emergency department.
Trend of bilirubin levels.
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Unfortunately, hyperbilirubinemia progressed and became the main problem (Figure 2).
Trend of AST/ALT levels.
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Liver enzyme levels peaked on postoperative day 3 and then settled to about 100-200 IU/L (Figure 3).
Trend of PT/aPTT.
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Thrombocytopenia continued, along with prolonged prothrombin time (INR, 1.2-1.5) and activated partial thromboplastin time (1.5-2.5 times of normal control) (Figure 4).
Pretransplantation CT scan showed a large area of infarction in the right lobe of the liver (arrows).
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A liver transplantation was indicated, and a pretransplantation CT scan showed poor enhancement of the right hepatic lobe on the periphery covering about 50% of the total area, which was suggestive of liver infarction (Figure 5).
Gross appearance of the patient's liver during liver transplantation
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Intraoperatively, there were multiple micronodular lesions on the liver surface with marked swelling of the liver parenchyma and diffuse devitalized liver tissue in the right lobe of liver with necrosis and in the left lobe peripheral zone accounting for about 70%-80 % of the total liver volume (Figures 6 and 7).
Transection of the resected native liver (1850 g).
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Intraoperatively, there were multiple micronodular lesions on the liver surface with marked swelling of the liver parenchyma and diffuse devitalized liver tissue in the right lobe of liver with necrosis and in the left lobe peripheral zone accounting for about 70%-80 % of the total liver volume (Figures 6 and 7).