Giant subcapsular hematoma of the liver — a rare complication after laparoscopic cholecystectomy

Abstract

The article shows a clinical case of an extremely rare complication after laparoscopic cholecystectomy — a giant subcapsular hematoma of the liver. The clinical, laboratory and instrumental data of the patient and the results obtained were analyzed. Analysis of the data from the operated patient did not reveal the main reason that could have caused the development of a giant subcapsular hematoma of the liver. The patient had no bleeding disorders, had not previously suffered any bleeding, and did not take anticoagulants as an outpatient. During the operations, no source of bleeding or damage to the liver parenchyma was identified. In addition, there was no evidence of focal liver lesions according to the preoperative ultrasound scan. Outpatient use of a drug from the group of antiplatelet agents, as well as short-term irregular use of analgesics to relieve periodic pain could provoke the development of this complication. Treatment of subcapsular hematoma of the liver mainly depends on the clinical condition of the patient and the size of the hematoma. With conservative management, the condition of the formed hematoma should be more carefully monitored over time using radiation diagnostic methods. If necessary and according to indications, do not exclude possible repeated laparoscopic intervention, including conversion to laparotomy, taking into account the data of clinical, laboratory and radiological research methods. In most cases, this condition requires conservative treatment. Patients with such a complication require careful hemodynamic monitoring and visual monitoring of the complications development. Probably, preference should be given to magnetic resonance imaging, since this method is the most objective and does not carry a radiation load. The main task is not to miss the moment of hematoma rupture and the development of fatal bleeding.