Liver Hematoma Research Articles

Formation and rupture of liver hematomas caused by intrahepatic gallbladder perforation: A case report and review of literature

Formation and rupture of liver hematomas caused by intrahepatic gallbladder perforation: A case report and review of literature

Subcapsular Liver Hematoma Rupture in HELLP Syndrome During Pregnancy: A Case Study and Multidisciplinary Approach

Subcapsular Liver Hematoma Rupture in HELLP Syndrome During Pregnancy: A Case Study and Multidisciplinary Approach

Subcapsular Liver Hematoma: One of the Many Faces of Acute Fascioliasis.

Subcapsular liver hematoma is an uncommon and underdiagnosed manifestation of fascioliasis. We report 6 cases and review 21 previous reports. The mean age was 51 years; 12 cases were from Peru; and 18 were women. Only 6 patients required surgical drainage. Medical management is the mainstay treatment.

Hepatic compartment syndrome, a rare complication after any liver insult or liver transplantation: Three case reports and literature review.

Hepatic compartment syndrome (HCS) is a rare but life-threatening entity that consists of a decreased portal flow due to intraparenchymal hypertension secondary to subcapsular liver hematoma. Lethal liver failure can be observed. We report three cases, and review the literature. A 54-year-old male was admitted for extensive hepatic subcapsular hematoma after blunt abdominal trauma. Initially, he underwent embolization of the hepatic artery's right branch, after which he presented clinical deterioration, major cytolysis (310 times the upper limit of normal [ULN]), and liver failure with a prothrombin time (PT) at 31.0%. A 56-year-old male underwent liver transplantation for acute alcoholic hepatitis. On postoperative day 2, he presented a hemorrhagic shock associated with deterioration of liver function (cytolysis 21 ULN, PT 39.0%) due to extensive hepatic subcapsular hematoma. A 59-year-old male presented a hepatic subcapsular hematoma five days after a cholecystectomy, revealed by abdominal pain with liver dysfunction (cytolysis 10 ULN, PT 63.0%). All patients ultimately underwent urgent surgery for liver capsule excision, hematoma evacuation, and liver packing, if needed. The international literature was screened for this entity. These three patients' outcomes were favorable, and all were alive at postoperative day 90. The literature review found 15 reported cases. HCS can occur after any direct or indirect liver trauma. Surgical decompression is the main treatment, and there is probably no place for arterial embolization, which may increase the risk of liver necrosis. A 13.3% mortality rate is reported. HCS is a rare complication of subcapsular liver hematoma that compresses the liver parenchyma, and leads to liver failure. Urgent surgical decompression is needed.

Two Cases of Postpartum HELLP Syndrome: A Rare Presentation of Preeclampsia-Associated Liver Disease and Hepatocellular Dysfunction

Background: HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe and sometimes fatal pregnancy condition characterized by hemolysis, increased liver enzymes, and low platelet count. While most cases occur before delivery, approximately 25% of cases manifest within 48 hours after delivery. One rare but life-threatening complication of HELLP syndrome is intraparenchymal liver hematoma. Case: In this report, we present two postpartum HELLP syndrome patients with diverse clinical manifestations. Case 1 involves a 30-year-old woman who presented with a significant subcapsular liver hematoma as a complication of postpartum preeclampsia-associated liver illness. Following conservative treatment, she improved significantly, and no surgical intervention was required. This type of subcapsular hematoma occurs in less than 2% of pregnancies complicated by HELLP. Case 2 describes an unusual HELLP presentation in a 38-year-old woman who was diagnosed with postpartum HELLP syndrome with acute liver injury and hepatic hemorrhage. Conclusion: These unique presentations underscore the significance of early detection and prompt treatment of postpartum HELLP syndrome, as it can significantly reduce risks to the mother’s health and improve overall outcomes.

Subcapsular Intrahepatic Hematoma As A Rare Complication of ERCP Secondary to Choledocholithiasis Case Report

Subcapsular Intrahepatic Hematoma represents a challenging clinical entity in the field of endoscopy. We present an interesting and rare case report and a bibliographic review to provide a comprehensive overview of this condition. The article delves into this condition, including its definition, risk factors, incidence, and management strategies. The discussion section highlights emerging approaches and future directions in managing subcapsular liver hematoma. In conclusion, the importance of evidence-based practices in addressing this rare complication of ERCP.

Hepatectomía derecha de urgencia por necrosis hepática infectada secundaria a colangiografía endoscópica

Subcapsular liver hematoma is a rare complication of endoscopic retrograde cholangiopancreatography. It can be potentially fatal and may result in rupture, massive bleeding, compression of the portal vein with thrombosis, necrosis and serious infections that require aggressive management. We report the case of a patient with acute cholangitis who developed a subcapsular liver hematoma after undergoing endoscopic retrograde cholangiopancreatography, complicated with hepatic necrosis due to compression of the portal vein pedicle and infected hepatic necrosis requiring an emergency right hepatectomy.

Management of spontaneous liver hematoma in vascular Ehlers Danlos syndrome: a case report

Management of spontaneous liver hematoma in vascular Ehlers Danlos syndrome: a case report

Preeclampsia and HELLP syndrome complicated by subcapsular liver hematoma and rupture.

Preeclampsia and HELLP syndrome complicated by subcapsular liver hematoma and rupture.

Complications related to the prehabilitation with preoperative pneumoperitoneum in loss of domain hernias: our experience in 180 consecutive cases.

Progressive pneumoperitoneum (PPP) is useful tool in the preparation of patients with loss of domain hernias (LODH). The purpose of this observational retrospective study was to report our experience in the management of complications associated with the PPP procedure after treating 180 patients with LODH and to report preventive measures to avoid them. Of the 971 patients with a ventral incisional hernia operated on between June 2012 and July 2022, 180 consecutive patients with LODH were retrospectively analysed. Diameters of abdominal cavity, and volumes of incisional hernia and abdominal cavity were calculated from CT scan, based on the modified index of Tanaka. Complications related to the PPP procedure (catheter placement and following insufflations of air) were recorded by Clavien-Dindo classification. Complications associated to PPP were 26.6%. No complications occurred during the administration of botulinum toxin (BT). Eighteen patients (10% of 180 patients) developed subcutaneous emphysema during the last days of the insufflations; there were 2 accidental perforations of the small bowel and four punctures with liver and splenic hematomas, detected during catheter placement; a laparotomy, however, was not needed because it was solved with conservative treatment. We diagnosed it as a peritoneum-cutaneous fistula due to the cutaneous atrophy secondary to chronic eventration. PPP is a safe technique well tolerated by patients, although at the cost of some specific complications. Hernia surgeons must understand these complications to prevent them and to inform the LODH patient about their existence.

Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome

This case report highlights the rare and life-threatening complication of ruptured subscapular liver hematoma in the setting of hemolysis, elevated liver enzymes, and low platelets syndrome, a complication associated with pre-eclampsia. A 30-year-old pregnant woman at 38 weeks of gestation presented with high blood pressure, exaggerated neurological reflexes, and high levels of albumin in her urine. Her condition deteriorated over time, and liver function tests revealed elevated readings. An emergency cesarean section was performed, during which a large liver tear with active bleeding and rupture of the liver capsule in the right lobe were discovered. An exploratory laparotomy revealed a massive hemoperitoneum with active bleeding, and hepatic packing was performed using three gauzes. Despite this, the patient's liver parameters continued to worsen, and she was transferred to the intensive care unit for further resuscitation. After 72 hours, she underwent a second operation to remove the gauze packing, and hemostasis was successfully achieved without any active bleeding. Early detection of ruptured subcapsular liver hematoma and a coordinated approach involving medical, obstetrical, radiology, and surgical teams can lead to successful treatment of this rare and dangerous complication.

Subcapsular Hepatic Hematoma Post Endoscopic Retrograde Cholangiopancreatography (ERCP): a case report

Subcapsular hepatic hematoma is a rare complication found after the ERCP, which can lead to abdominal pain, anemia, fever and hypotension. The case of a 34-year-old patient who developed a subcapsular liver hematoma after ERCP is presented in this paper. The patient had abdominal pain and anemia, which did not improve with conservative treatment. Drainage therapy was performed, leading to remission of the condition.

Subcapsular Hematoma of the Liver and Right Renal Hematoma Complicating Eclampsia: A Case Report

Subcapsular haematoma of the liver (SCLH) is a rare and serious complication in pre-eclampsia, occurring in a relatively stereotyped but non-specific clinical picture, which often leads to a delay in diagnosis. Its secondary rupture is one of the most serious obstetrical complications with an estimated maternal mortality of 50-75% and fetal mortality of 60-80%. We reported a case of a 37-year-old woman presented to the emergency department with postpartum eclampsia, which was revealed by generalized tonic-clonic seizures. On the second day of hospitalization, the patient developed persistent epigastric pain that was resistant to analgesic treatment. Bedside abdominal ultrasound showed a moderate amount of peritoneal effusion, and a complement CT scan revealed a subcapsular hematoma of liver with moderate hemoperitoneum and right renal hematoma. The therapeutic decision was to continue close clinical and laboratory monitoring twice daily. Improvement was noted in laboratory tests on the fourth day of hospitalization, with normalization on the twelfth day.

Hemostatic Control in Liver Injury, A Practical Review

The liver is the most usually damaged organ following blunt trauma, which can occur as a result of blunt, thoracic, or abdominal trauma. Penetrating liver damage is accompanied with potentially fatal lesions of key neighboring tissues (e.g., vena cava, aorta). (The size and depth of the liver hematoma and/or laceration as discovered on computed tomography (CT) or at the time of surgery are used to classify liver damage (I through VI). Injury severity correlates with greater morbidity and death. Exploratory laparotomy for trauma involves of first controlling bleeding using abdominal tamponade in all four quadrants, then inspecting the intra-abdominal organs and, if necessary, exploring the retroperitoneum. Before treating gastrointestinal damage, active bleeding is addressed.

A 39-Year-Old Woman with Endometriosis Who Developed a Subcapsular Liver Hematoma Following Laparotomic Surgical Left Adnexectomy, Rectosigmoid Anastomosis, and Bilateral Ureteral Reimplantation.

BACKGROUND Endometriosis is a chronic inflammatory disease caused by endometrial tissue that grows outside the uterus. Deep endometriosis surgery is associated with considerable rates of complications, although such rates are lower in surgical procedures carried out by expert surgical teams. This report details a case of a rare but life-threatening complication in the postoperative period following 72 h of endometriosis surgery: a giant subcapsular hepatic hematoma, which was successfully managed conservatively. CASE REPORT Here we describe the case of a 39-year-old woman with deep endometriosis with ureteral, ovarian, and intestinal involvement requiring multidisciplinary surgery. She presented with severe anemia, respiratory distress, and oliguria 72 h postoperatively. A 3-phase computed tomography (CT) scan revealed a giant intrahepatic subcapsular hematoma (180×165×50 mm) lateral to the right hepatic lobe, which was managed conservatively. The patient evolved favorably and the hematoma was reduced (77×16 mm) in a follow-up CT scan performed 5 months later. CONCLUSIONS Giant liver hematoma is a rare, life-threatening complication. The current experience relating to its management remains largely limited owing to the rarity of the condition and paucity of published cases. Actually, we found no articles on hepatic hematoma in the context of endometriosis surgery. Early diagnosis and treatment are essential to reduce the patient's risk of death. Imaging diagnosis plays an essential role.

The conservative management of a large hepatic subcapsular hematoma in a pregnant woman with preeclampsia: A case report

Hepatic subcapsular hematoma is a rare but potentially life-threatening complication that is caused by preeclampsia and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, which may be manifest with nonspecific signs and symptoms. The present case was a 36-year-old woman with a secondary subcapsular liver hematoma as a rare complication of HELLP syndrome. The patient complained of nausea, vomiting, pain in the right upper quadrant of the abdomen, epigastric pain, and severe pain in the right shoulder. On the fourth day after delivery, a computed tomography (CT) scan was performed on the patient, showing a large subcapsular hematoma around the liver. Six weeks after delivery, the follow-up ultrasound exhibited no residual hematoma or free peritoneal fluid, and the patient’s blood pressure was controlled without taking medication.

Predicting bleeding after liver biopsy using comprehensive clinical and laboratory investigations: A prospective analysis of 302 procedures

BackgroundLiver biopsy carries a small risk of bleeding complications. No validated clinical or laboratory tool helps predict liver biopsy–related bleeding. ObjectivesTo determine whether global hemostasis tests and/or a clinical questionnaire could identify patients at risk of liver biopsy–related bleeding. Patients/MethodsConsecutive patients scheduled for liver biopsy with an overnight hospital stay were prospectively included. Before liver biopsy, routine hemostasis tests, Platelet Function Analyzer 100, thromboelastometry, thrombin generation assay, plasma clot lysis time, and a clinical questionnaire were performed. Bleeding was defined as a liver hematoma or new free fluid on a systematic ultrasound performed 24 h after liver biopsy or a decrease in hemoglobin level of 2 g/dL or more in patients with pre‐existing free fluid in the abdominal cavity. ResultsThree hundred two patients were included: 173 underwent percutaneous and 129 transjugular liver biopsy. There were 21 bleeding episodes (7%); 20 based on ultrasonographic criteria, 1 on laboratory criteria. None of the hemostasis tests and no item of the clinical questionnaire were associated with liver biopsy–related bleeding in the overall study group. Same results were obtained in subgroup analyses focusing on patients who underwent percutaneous liver biopsy, transjugular liver biopsy, or on patients with cirrhosis. Pain 2 h after liver biopsy was more frequent in patients with liver biopsy–related bleeding (55% vs. 23% p = .002). ConclusionsAn extensive hemostasis workup, including global hemostasis assays, does not improve prediction of liver biopsy–related bleeding. Pain 2 h after liver biopsy should alert the clinician to the possibility of procedure‐related bleeding.

Case Report on HELLP Syndrome with Severe Anemia

Background: The pregnancy condition known as the HELLP-syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets) is connected to preeclampsia and may result in sub capsular liver hematomas. Estimates of incidence range from 0.5 to 7.6 per 1000 births, and between 8% and 24% of HELLP cases are considered severe .Here we are introducing a 24-year-old patient who visited to gynaecological outpatient department unit with complaint of abdominal and chest pain specially in right upper side, bleeding, changes in vision, heat intolerance specially in night but cold hand, insomnia weight loss, nausea, and vomiting, sweating, dizziness, tremor, increase appetite headache, edema over feet since last one month. The patient underwent through a blood investigation (CBC), D-dimer test, liver enzyme test, and sonography and magnetic resonance image. After all the investigation patient shifted for lower segment caesarean section(LSCS) After that the patient is shifted to ward for further management after that she has administered the right dose of anti- thyroid medication, anti- conversant beta blocker, anti edoema and other suppository medication. After treatment, the patient's condition was improved than before.

S3162 Subcapsular Hepatic Hematoma: A Rare Complication of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome in Pregnancy

Introduction: Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is seen in 0.1-1.0% of pregnant people overall, with the risk increased by preeclampsia. Common complications of HELLP include bleeding, disseminated intravascular coagulation (DIC), and abruptio placentae. Here we present a rare case of subcapsular liver hematoma that occurs in only 1% of HELLP patients. Case Description/Methods: A 29-year-old woman, gravida 4, para 3 with a history of preeclampsia during prior pregnancies presents with acute onset epigastric and pelvic pain for one day at 27th-week gestation. The severe, intermittent epigastric pain radiates laterally down to the pelvis and is aggravated with laying down. The review of systems and vitals were normal. Mild tenderness in the right upper quadrant (RUQ) was noted. Labs showed high ALT 233 U/L, AST 378 U/L, low platelet 108,000/microL, and high LDH 519 IU/L. The rest of the labs were normal. She underwent an emergent C-section at admission for HELLP syndrome. An ultrasound showed two complex hypoechoic hepatic mass-like areas measuring 9.3cm and 3.5 cm in the setting of hepatomegaly and diffuse hepatic steatosis suggestive of focal fatty sparing or cavernous hemangioma. Biliary sludge without cholecystitis or cholelithiasis was also noted. An MRI with IV contrast with the liver mass protocol was obtained which showed hepatic subcapsular hematoma of dimensions 24 cm x 9.2 cm x 3.9 cm at the level of the right hepatic lobe. The pain continued to worsen with a drop in hemoglobin from 12.8 gm/dl at admission to 7.1 gm/dl on day 4. IR was consulted for rupture concern and recommended CT angiography of abdomen and pelvis with and without arterial/venous phase that showed similar appearing subcapsular hematoma without an active bleed. Underwent image-guided hepatic angiography that showed large perihepatic hematoma along the right lateral abdominal wall without active contrast extravasation. Right hepatic artery embolization was done with a reduction in peripheral hepatic arterial blood flow by 25%. Later hemoglobin stabilized, liver enzymes improved, and the patient was discharged home 6 days later in a clinically stable state (Figure). Discussion: Early diagnosis of subcapsular hematoma is challenging due to nonspecific signs and symptoms but crucial for improved outcomes. Physicians should evaluate for a subcapsular hematoma in patients with HELLP and RUQ pain or hypotension. Therapeutic options for ruptured hematomas include laparotomy and hepatic artery embolization.Figure 1.: Coronal section of MRI with IV contrast (Liver mass protocol) of abdomen and pelvis demonstrates subcapsular hepatic hematoma involving the hepatic dome and right hepatic lobe approximately measuring 24 cm in craniocaudal dimension.

Early Detection of Nonalcholic Fatty Liver (NAFLD) on Ultrasound

Background: Nonalcoholic fatty liver abnormality is more typical determination in clinical practice and around the world. Obesity and diabetic individuals play a basic role in the development and improvement of this disease. Purpose: This study was done to detect and find out the frequency of nonalcoholic fatty liver abnormalities on ultrasound at Al Noor Ultrasound and KTH hospital Peshawar Pakistan. To review the information of NAFLD and also the hazardous factors for its advancement and the regions where future research is important. Methods: Cross sectional study was done and overall 230 patients were taken from ultrasound examination. Results: Total 230 patients were examined on Color Doppler Ultrasound and confirmed 150 diseased patients. In total patients the males are 54.34% and females are 45.65%. The most frequent disease in this study was nonalcoholic fatty liver and detected in 104 (69.33%) patients (75 males, 29 females) and although the remaining diseases frequencies were liver hydated cyst 12 (8%) patients, hepatitis 11 (7.33%) patients, liver cirrhosis 10 (6.66%) patients, hepatomegaly 8 (5.33%) and least frequent liver hematoma in 5 (3.33%) patients. Conclusion: The most frequent disease found in this study was nonalcoholic fatty liver. The key cause of this disease is the obesity and diabetic patients. Ultrasound is the modality of choice for early detection of nonalcoholic fatty liver disease.