Subcapsular Hepatic Hematoma Research Articles

Cyst‐like extension of hepatic subcapsular bleeding caused by ruptured hepatocellular carcinoma into the bursa omentalis

An 81-year-old man, who experienced upper abdominal pain after shoveling snow, was admitted to a local hospital where a computed tomography (CT) showed a cystic lesion adjoining the pancreas. He was transferred to our department for detailed investigations and treatment. On ultrasonography, a tumor of the caudate lobe of the liver, with which the cystic lesion was continuous, was seen. The tumor of the caudate lobe of the liver was enhanced in the early phase of the CT but was washed out in the delayed phase. Subsequently, T(1)-weighted and T(2)-weighted magnetic resonance imaging (MRI) images showed a low intensity and a high intensity, respectively. Because the cystic lesion was continuous with the tumor of the caudate lobe of the liver, its CT value was higher than that of water, and both the T(1)-weighted and T(2)-weighted MRI images showed a high intensity, which was attributed to a hematoma. Examination of the image suggested that rupture of a hepatocellular carcinoma (HCC) might have caused intracavitary hemorrhage. After the HCC was treated by transcatheter arterial embolization therapy, the patient was discharged. Subsequently, tumor enlargement was confirmed, and surgical removal of the tumor was conducted at the hospital where the patient had originally presented. On histology, moderately differentiated HCC was diagnosed, but the cyst-like lesion was confirmed to be a hepatic subcapsular hematoma extending into the bursa omentalis. Although ruptured HCC often causes intraperitoneal bleeding, this rare case showed a cyst-like imaging finding in the form of a subcapsular hematoma within the bursa omentalis.

Heparininduzierte Thrombozytopenie mit Lebereinblutung nach Polytrauma

Up to 3% of patients receiving unfractioned heparin develop heparin-induced thrombocytopenia (HIT). We report on a polytrauma patient who developed severe HIT with bilateral pulmonary embolism. Lepirudin treatment resulted initially in rapid improvement. Ten days after discharge the patient complained of abdominal pain. A large subcapsular hepatic hematoma was diagnosed, requiring repeat surgery and ending in secondary sclerosing cholangitis. This process can potentially be avoided by regular tests of lepirudin concentration and coagulation.

Modern approach to post-traumatic hepatic hematoma – US guided percutaneus drainage

Subcapsular and intraparenchymatous hepatic hematomas (HH) raise special management problems due to parenchymatous associated lesions. Despite intense and rapid liver regeneration, this process is affected by the presence of the bile. Therefore the nonoperative management determines a weak and slow healing. The drainage of the fluid (biliohepatic collection), by surgical hepatostomy or percutaneous drainage, promotes optimal cure. Laparotomy with surgical solutioning of the HH is a method associated with important morbidity and mortality, but percutaneous transhepatic US guided drainage represents a minimal invasive alternative for selected cases. We performed percutaneous US guided drainage in three patients with symptomatic posttraumatic HH, six weeks after the accident. The liquid collections were initially sanguine, then biliary. The punction was followed by the placing of a multiperforated tube with enclosed drainage for a maximum period of 21 days. The evolution proved to be rapidly favorable with complete healing, clinical, imagistic (ultrasonography, computed tomography) and biological, 3 months after the procedure. The study confirms the efficient minimal invasive approach for selected cases of posttraumatic subcapsular HH.

Management of Bleeding after Percutaneous Transhepatic Cholangiography or Transhepatic Biliary Drain Placement

Bleeding complications occur in 2 to 3% of percutaneous transhepatic biliary drains. These complications include: hemothorax, hemoperitoneum, subcapsular hepatic bleeding, hemobilia, melena, and bleeding from the percutaneous biliary drain. The bleeding sites can be classified into (1) perihepatic bleed sites (hemothorax, hemoperitoneum, subcapsular hepatic hematoma), (2) gastrointestinal bleeding (hemobilia and/or melena), and (3) bleeding from the percutaneous biliary drain itself, which is the most common clinical presentation. There are several bleeding sources. These include skin-bleeds, intercostal artery, portal vein, hepatic vein, and the hepatic artery. There are a variety of maneuvers that can be utilized in the management of bleeding percutaneous biliary drains. These include tractography, angiography, tract embolization, arterial embolization, and tract site changes. This article proposes a protocol for approaching bleeding complications after percutaneous biliary drain placement and details the diagnostic and therapeutic procedures in the management of these bleeding complications.

Subcapsular Liver Hematoma in Metastatic GIST On Gleevec Therapy

We report two patients with metastatic gastrointestinal stromal tumor (GIST) who had large subcapsular hepatic hematomas that developed while on imatinib mesylate (Gleevec) therapy. We describe the pertinent radiologic features of the subcapsular hematomas in these patients, and discuss possible etiologies for the bleeding in each patient.

Hematoma subcapsular hepático, una complicación infrecuente de los estados hipertensivos del embarazo

Subcapsular hepatic hematoma is an infrequent and severe complication of hypertension in pregnancy and should be suspected when there are clinical signs compatible with this diagnosis, which should be confirmed by abdominal computed tomography. Prompt diagnosis and treatment are important to avoid rupture, thus improving the high associated maternal and fetal morbidity and mortality.

Subcapsular hepatic hematoma after ERCP

Subcapsular hepatic hematoma after ERCP

Hématome sous-capsulaire hépatique après cholangiopancréatographie rétrograde endoscopique : description d’un cas clinique et revue de littérature

Subcapsular hepatic hematoma is a rare complication of endoscopic retrograde cholangiopancreatography. The mechanism of this lesion has not been clearly established. The following observation clarifies the physiopathology, as well as providing a review of the various cases described in the literature.

Hepatic hematoma in a neonate with a high level of alpha-fetoprotein

Hepatic hematomas in neonates are uncommon lesions. When they are large or subcapsular in location, they can rupture with clinical signs of hemoperitoneum. We report a case of subcapsular hepatic hematoma (SHH) associated with a high level of alpha-fetoprotein (AFP), for which diagnosis was made with conservative management, following up with the reduction in size at ultrasound examination and the reduction of the level of AFP.

Hepatic Subcapsular Hematoma Secondary to Intrahepatic Pseudoaneurysm Following Cholecystectomy

Hepatic Subcapsular Hematoma Secondary to Intrahepatic Pseudoaneurysm Following Cholecystectomy

Closing the gap between decision and delivery—Amniotic fluid embolism with severe cardiopulmonary and haemostatic complications with a good outcome

Perimortem caesarean section is very rare, mostly resulting in high mortality of mother and/or fetus. We report a case of successful resuscitation of both mother and newborn following maternal cardiac arrest prior to delivery. Postoperative outcome was complicated by severe bleeding and coagulopathy following fibrinolysis and subcapsular hepatic haematoma. We consider a fast reaction time based on a special in-hospital emergency team for immediate caesarean section and an aggressive management of coagulopathy as major factors that led to both patients recovery without neurological sequelae.

Life-Threatening Complication after Right Renal Extracorporeal Shock Wave Lithotripsy: Large Hepatic Haematoma Requiring Embolisation of the Right Hepatic Artery

We present the case of a young female patient who developed a large subcapsular hepatic haematoma following extracorporeal shock wave lithotripsy (ESWL) administered to a stone in the right kidney. Severe haemorrhagic shock required a partial coiling embolisation of the right hepatic artery.

HELLP syndrome et hématome sous-capsulaire du foie rompu. Stratégie thérapeutique à partir d'un cas clinique

We report a case of spontaneous hepatic rupture secondary to HELLP syndrome. A favourable evolution was observed after massive transfusion and surgical management limited to hepatic packing. Subcapsular hepatic haematoma is a rare complication of preeclampsia occurring mainly in the context of HELLP syndrome. A high maternal and foetal mortality is observed. Different therapeutic options are presented including medical, surgical and radiological interventions. A unique strategy cannot be defined. Multidisciplinary approach seems mandatory. Surgery should remain as less aggressive as possible.

An Unusual Complication of Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiography (ERCP) has a greater potential for procedure-related complications than other endoscopic procedures in the upper gastrointestinal tract (1). Extraluminal hemorrhagic complications after ERCP are relatively rare but potentially life threatening and, thus, should be identified and treated rapidly (2). In this report, we describe a very rare complication—subcapsular hepatic hematoma—resulting from a guide wire–associated injury that developed 2 days after ERCP. A 41-year-old man was admitted to our hospital with the complaints of new-onset (few hours) right upper quadrant pain. He was known to have hilar cholangiocarcinoma for the last 8 months and his last biliary stent had been replaced 2 days before as an out-patient in our ERCP unit. Physical examination revealed left upper quadrant tenderness and subfebrile fever (37.8◦C). Laboratory data were as follows: hemoglobin 12.1 g/dL, hematocrit 38%, MCV 93 fL, white blood cell count 13.5 × 109/L, platelet count 437 × 109/L. Serum biochemical tests were within normal limits other than alkaline phosphatase 2140 U/L (38–155 IU/L); γ -glutamyltransferase, 508 U/L (15–60 U/L); total bilirubin, 6.16 mg/dL (0.1– 2.0 mg/dL); and direct bilirubin, 4.74 mg/dL (0.1–0.8 mg/dL). Abdominal sonography revealed a 78× 41mm in diameter collection in the anterior part of the liver (Figure 1). There were 3 stents in the common bile duct and intrahepatic biliary ducts. Computerized tomography demonstrated the subcapsular hematoma. He was hospitalized and followed with palliative measurements including intravenous fluid replacement, antibiotics

Case Report: Subcapsular Hepatic Hematoma: Retraction Injury During Laparoscopic Adrenalectomy

We present a case of subcapsular hepatic hematoma resulting from retraction of the liver during laparoscopic adrenalectomy. We discuss the management and prevention of this rare and important complication.

Survival following amniotic fluid embolism and cardiac arrest complicated by sub-capsular liver haematoma

We describe the anaesthetic and intensive care management of a 38-year-old mother with presumed amniotic fluid embolism who suffered cardiorespiratory collapse following delivery of a normal baby by caesarean section. After initial resuscitation, her recovery was complicated by development of disseminated intravascular coagulation and a large sub-capsular hepatic haematoma. We describe the initial resuscitative efforts and subsequent intensive therapy to full neurological recovery and discharge from hospital.

Subcapsular Hepatic Hematoma after Guide Wire Injury During Endoscopic Retrograde Cholangiopancreatography: Management and Review

Complications of endoscopic retrograde cholangiopancreatography (ERCP) that are associated with the guide wire are fortunately rare, but may be more common than is reported. We describe the case of a 43-year-old woman with obstructive jaundice from metastatic pancreatic cancer who underwent an elective ERCP for biliary stent placement. This was complicated by guide wire-associated injury that resulted in the development and eventual rupture of a subcapsular hepatic hematoma and which was successfully treated with nonsurgical management. If identified and treated rapidly, using a multidisciplinary approach (i. e., with medical, interventional radiology, and surgical input), such patients can be conservatively managed.

Subcapsular hepatic hematoma after ERCP: case report and review

The case of an 88-year-old woman who underwent ERCP for evaluation of jaundice and abdominal pain is reported. The seemingly uneventful procedure demonstrated a double duct sign. As this raised a suspicion of malignancy, a biliary stent was placed. The patient subsequently developed a hepatic subcapsular hematoma, which was managed successfully with conservative therapy.

Contemporary outcomes of ambulatory laparoscopic cholecystectomy in a major teaching hospital.

Ambulatory laparoscopic cholecystectomy is an established practice in our institution, with an experience of more than 800 cases. The present study is conducted to evaluate the contemporary outcomes of day-case laparoscopic cholecystectomy in the setting of a major teaching hospital. A retrospective analysis of 200 patients who underwent ambulatory laparoscopic cholecystectomies was performed to evaluate the postoperative morbidity, unplanned admission, and readmission rates. Causes for unanticipated admission and readmission were analyzed. Uneventful recovery was attained in 185 (92.5%) patients. The mean length of the operation was 56 +/- 20 (SD) minutes. There was no hospital mortality, and no patient required conversion to open cholecystectomy. Nine patients were admitted overnight after operation because of nausea and vomiting (n = 3), pain (n = 2), urinary retention (n = 2), medical observation n = 1), and patient's preference (n = 1), leading to an unanticipated admission rate of 4.5%. Six patients required readmission because of postoperative complications (n = 4) and abdominal pain (n = 2), giving a readmission rate of 3%. The overall postoperative morbidity rate was 3% (n = 6), including retained stones n = 4), bile leakage (n = 1), and hepatic subcapsular hematoma (n = 1). Ambulatory laparoscopic cholecystectomy is a safe practice in appropriately selected patients. Postoperative nausea and vomiting was the commonest reason for unanticipated admission after operation, and retained stones was the most frequent postoperative morbidity necessitating readmission.

The Uncertainty Of Radio Frequency Treatment Of Renal Cell Carcinoma: Findings At Immediate And Delayed Nephrectomy

Radio frequency thermal therapy for the ablation of renal cell carcinoma has been reported. Outcomes are usually measured by imaging alone. We have performed ex vivo and in vivo experiments using radio frequency in porcine models in our laboratory. We now report our early experience in the treatment of renal cell carcinoma in patients who underwent post-radio frequency radical or partial nephrectomy. We treated 10 patients diagnosed with small renal masses with radio frequency. All masses were biopsied before treatment. In 4 patients 5 renal cell carcinomas were treated with radio frequency after surgical exposure of the tumor followed immediately by partial or radical nephrectomy (acute group). Six other patients were treated percutaneously with ultrasound or computerized tomography guided radio frequency under local anesthesia and intravenous sedation 7 days before partial or radical nephrectomy (delayed group). A median of 2 radio frequency cycles was applied. Mean total heating time was 17 minutes 15 seconds. Specimens were analyzed grossly and histologically. Triphasic contrast-enhanced computerized tomography and/or magnetic resonance imaging was performed before and 7 days after radio frequency treatment in the delayed group. Mean radiological largest diameter of all 11 masses was 2.4 cm. and mean gross diameter was 2.2 cm. Pathological examination demonstrated residual viable tumor in approximately 5% of the volume in 4 of the 5 tumors in the acute group and in 3 of the 6 masses of the delayed group. In 1 delayed case the viable tumor appeared to be in contact with the renal vein. No significant complications were observed in 9 of the 10 patients. In 1 delayed case, a subcapsular hepatic hematoma, biliary fistula and pneumonia developed and resolved. Based on our experience, we continue to consider percutaneous radio frequency for the treatment of small renal cell carcinomas as a potentially curative therapy. However, complete tumor cell death appears to be difficult to achieve with our current treatment protocol. More phase II testing is indicated to ensure that this technique is an effective and reproducible treatment alternative.