Subcapsular Liver Hematoma Research Articles

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.

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

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

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.

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.

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.

Sub-Capsular Hematoma of the Liver Complicating Preeclampsia

Subcapsular hematoma of the liver Subcapsular hematoma of the liver (SCLH) is defined as an anatomical-clinical entity corresponding to the appearance of a hematic collection located between the intact GLISSON capsule and the hepatic parenchyma. It is a rare complication of pregnancy with a high maternal-fetal mortality, occurring most often in the context of pre-eclampsia or HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome). We report the case of a 25-year-old parturient, primiparous woman, with no previous history, admitted to the emergency room for shock in a 29-week amenorrhea pregnancy. Ultrasound examination revealed a ruptured sub capsular hematoma of the liver. An urgent surgical exploration was required, during which a rupture of the subcapsular hematoma of the liver was revealed, accompanied by a state of hemorrhagic shock. The management consisted in a polytransfusion with suture of the hepatic lesion without paking. The evolution was favorable with clinico-biological normalization and the patient was declared discharged at D10 of her hospitalization.

976 Traumatic Damage to The Liver Capsule: An Unusual Cause of Small Bowel Obstruction

Abstract A 57-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side whilst cycling but had not sought medical attention. On admission, a CT scan showed small bowel obstruction and he underwent an emergency laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. Small bowel obstruction is a common presentation in A&E and is responsible for half of emergency laparotomies in the UK each year. Although hepatic haematomas are also a relatively common complication of blunt trauma to the abdomen, associated bowel herniation into the liver capsule is very unusual. We believe this is the first time such a case of small bowel obstruction has been reported in the literature and we discuss details of operative management and highlight key learning points.

Misdiagnosed case of liver sub-capsular hematoma in a child managed with percutaneous pigtail catheter drainage

Hepatic hematoma sometimes has a non-specific presentation with non-specific history especially in pediatric age group. Clinical signs and symptoms may vary & sometimes misleading results in delays in diagnosis and higher morbidity. We present a case of a 9-year old male child with a liver subcapsular hematoma with Perihepatic collection, initially misdiagnosed as liver abscess.

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The pregnancies after the 28th week of gestation have a formidable complication - preeclampsia, which can lead to the development of the HELLP syndrome if not timely diagnosed and treated. That leads to multiple organ failure with decompensation of the basic vital functions. In half of the cases the DIC syndrome and acute renal failure may develop; rather seldom, subcapsular haematoma of the liver develops, while the liver rupture can lead to extremely serious consequences for a pregnant woman or a woman in labor, up to fatal outcome. There is little information about the treatment tactics for that pathology. It is still unclear if the patients with a large subcapsular haematoma of the liver due to HELLP syndrome should be operated. The article presents a clinical case of conservative treatment of a patient with this complication.

Spontaneous rupture of subcapsular liver hematoma in sudden onset severe preeclampsia

Spontaneous rupture of subcapsular liver hematoma in sudden onset severe preeclampsia

HELLP syndrome complicated by subcapsular liver hematoma

Abstract Rationale: Subcapsular liver hematoma (SLH) is a rare but potentially fatal complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. The SLH incidence rate is about 1% to 2% in patients with preeclampsia and HELLP syndrome. Patient concerns: A 28-year-old woman (gravida 3, parity 2) was admitted to the hospital at 26+1 gestation weeks because of upper abdominal discomfort of 2 weeks duration. Diagnoses: The patient was diagnosed with pre-eclampsia and HELLP syndrome. CT scan confirmed the presence of SLH. Interventions: The patient was treated with magnesium sulphate and Glucocorticoid was given for fetal lung maturation. But the blood pressure continued to rise. Cesarean section was performed, and a male infant was delivered with APGAR score 7. Outcomes: SLH resolved after the operation and the patient was discharged 6 days later. The newborn was discharged 1 month later from the intensive care. Lessons: HELLP syndrome complicated with SLH is a life-threatening condition for pregnant women and fetus. The decrease in blood volume due to bleeding can mask the underlying pre-eclampsia and delay the diagnosis and treatment.

SUBCAPSULAR LIVER HEMATOMA – A COMPLICATION AFTER LAPAROSCOPIC CHOLECISTECTOMY

Subcapsular liver haematoma is among the most severe complications after laparoscopic cholecistectomy, but occurs rarely. The hematoma is usually located around the right lobe of the liver (in 75% of patients). We report the case of a 71 year old patient who underwent laparoscopic cholecistectomy for acute colecistitis. Initial postoperative evolution was favorable. On postoperative day 3 patient presents intense abdominal pain and decreased hemoglobin. The CT shows subcapsular hepatic hematoma. Emergency surgery is performed for signs of hemorragic shock with evacuation of the hematoma and hemostasis. Postoperative evolution is good. There are several theories proposed for the occurance of a subcapsular hematoma of the liver after laparoscopic cholecistectomy. Among these, the presence of a hemangioma, the use of NSAIDs or low molecular weight heparin. No clear mecanism is known and the only clinical sign can be abdominal pain. This case reminds us that we must take abdominal pain seriously after cholecystectomy in order to identify severe complications that can occur, such as hepatic subcapsular hematoma.

S2733 A Curious Case of a Bleed Without a Cause

INTRODUCTION: Spontaneous subcapsular hematoma of the liver is usually associated with pregnancy, coagulopathy or liver lesion. We report a rare case of spontaneous subcapsular liver hematoma without any of the above risk factors. CASE DESCRIPTION/METHODS: A 59-year-old lady with a history of hypertension presented with sudden-onset in the right upper abdomen, right chest, shoulder and neck pain. She was otherwise hemodynamically stable other than being mildly hypertensive. Work-up for cardiac ischemia was negative. She was noted to have a low hemoglobin of 10.4 g/dl (prior baseline was 13.7 g/dL) and she had mild hepatocellular injury (ALT 32 IU/L, AST 31 IU/L). She underwent CT scan to rule out pulmonary embolism which incidentally revealed a large subcapsular liver hematoma. MRI abdomen confirmed a large lenticular shaped subscapular collection along the right lobe of the liver measuring approximately 12 × 4 × 16 cm. There was no focal hepatic lesion to explain the cause of bleeding. She did not recall any preceding trauma and there was no obvious trauma on exam. She was not taking any blood thinners. She admitted to inadvertently using oral contraceptives (OCP) for over 30 years for purely birth control purposes. The patient was admitted for observation and remained clinically stable over the next few days. At her 1-month follow-up, an office ultrasound showed that the size of the hematoma had decreased when compared to her prior ultrasound during her hospitalization (thickness from intercostal view decreased from 42 mm to 35 mm). At her 1-year follow-up, an MRI abdomen was repeated that showed a minimal residual hematoma and no discrete underlying lesion. DISCUSSION: Spontaneous subcapsular hematoma of the liver represents an accumulation of blood between the capsule of Glisson and the liver parenchyma, and is frequently located around the right lobe. If it ruptures into the peritoneum, it can be potentially fatal. Our case is unique in that none of the usual risk factors such as pregnancy, trauma, blood thinner use or underlying liver lesion were present. To our knowledge, there are very few similar case reports that describe spontaneous subcapsular hepatic hematoma. OCP use is generally associated with the development of hepatic adenoma, which can in turn cause spontaneous subcapsular hematoma. Theoretically, long-term OCP use in a post-menopausal hypertensive lady (such as in our case) may mimic the pathophysiology of pregnancy and independently lead to spontaneous subcapsular bleeding.Figure 1.: MRI showing large hepatic subcapsular hematoma and no focal lesion.Figure 2.: MRI showing nearly resolved hepatic subcapsular hematoma.