Subcapsular Liver Hematoma Research Articles

S2448 Rare Occurrence of a Spontaneous Unruptured Subcapsular Liver Hematoma

S2448 Rare Occurrence of a Spontaneous Unruptured Subcapsular Liver Hematoma

Large subcapsular hematoma of the liver due to faja corset: a rare case report

BackgroundSubcapsular hematoma of the liver is a potentially life-threatening but extremely rare condition. It is often caused by a blunt trauma or other predisposing conditions such as a liver tumor, intra-tumor hemorrhage, surgery, preeclampsia, liver biopsy, and hemodialysis. Predisposing causes of liver hematoma include its large size and proximity to fixed structures. To date, there have been no reported cases of subcapsular liver hematoma caused by tight clothing such as corsets. Our case report is about an extremely rare case of subcapsular hematoma of the liver caused by wearing a tight faja corset in a young healthy female.Case presentationA forty-five-year-old Spanish female without any underlying health problems presented with sudden onset epigastric and right upper quadrant abdominal pain after wearing a faja corset the night prior to the hospital presentation. CT abdomen was noted for subcapsular hematoma of the liver. Her symptoms persisted and repeat CT abdomen showing worsening of the liver hematoma. Patient had interventional radiology (IR) guided drainage and was subsequently discharged home.ConclusionsSubscapular liver hematomas need to be considered in patients presenting with acute onset abdominal pain after wearing certain tight clothing. The necessity of an early and accurate diagnosis is vital for management as hemodynamically stable patients can be managed conservatively. Our patient was managed with IR-guided aspiration drainage of the hematoma. Surgery can be considered a last resort in case of life-threatening hemodynamic instability, peritoneal signs, free abdominal fluid, and failure of arterial embolization. Our case highlights the importance of early recognition of traumatic subcapsular hematomas to prevent life-threatening complications.

Improved clinical outcome using transarterial chemoembolization combined with radiofrequency ablation for patients in Barcelona clinic liver cancer stage A or B hepatocellular carcinoma regardless of tumor size: results of a single-center retrospective case control study

BackgroundTo determine the safety and efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (hereafter, TACE-RFA) in treating Barcelona Clinic Liver Cancer (BCLC) Stage A or B (hereafter, BCLC A/B) hepatocellular carcinoma (HCC) patients, and to explore the range of tumor sizes suitable for combination therapy.MethodsThis retrospective study assessed the consecutive medical records of HCC patients with BCLC A/B who received TACE-RFA or TACE from September 2009 to September 2018. Progression-free survival (PFS), overall survival (OS), therapeutic response, and complications were compared between the two groups.ResultsAmong 2447 patients who received TACE-RFA or TACE, 399 eligible patients were enrolled in our study, including 128 patients in the TACE-RFA group and 271 patients in the TACE group. Compared with the TACE group, the PFS and OS rates of 1,3,5,8 years in the TACE-RFA group were significantly better, with higher objective tumor regression rate and better disease control rate. RFA treatment did not increase the risk of death in patients with HCC, and both liver subcapsular hematoma and bile duct injury were improved by symptomatic treatment. Serum α-fetoprotein level and treatment method were important independent prognostic factors for OS, whereas albumin, hepatitis B and treatment method were important independent prognostic factors for PFS. Subgroup analysis showed that patients in the TACE-RFA group always showed better OS and PFS.ConclusionsTACE-RFA had an advantage over TACE alone in prolonging PFS and improving OS in HCC patients with BCLC A/B, and can benefit patients regardless of tumor size.

2296 Hepatic Rupture Due to Subcapsular Liver Hematoma in HELLP Syndrome

INTRODUCTION: Subcapsular liver hematoma (SLH) is a rare complication that occurs in about 1 in 45,000 pregnancies almost exclusively in the setting of preeclampsia or HELLP syndrome. Subcapsular and intraparenchymal hemorrhage can lead to hepatic capsular rupture which is associated with significant maternal and fetal mortality. We present a rare case of a pregnant woman who developed HELLP syndrome complicated by ruptured subcapsular liver hematoma. CASE DESCRIPTION/METHODS: A 33-year-old woman at 31 weeks of pregnancy presented with generalized abdominal pain. She was hypertensive and urinalysis showed proteinuria thus the clinical scenario was concerning for preeclampsia. Development of non-reassuring fetal heart tones led to an emergent C-section with delivery of a healthy infant. Within hours she became hypotensive and somnolent requiring vasopressors and intubation. The patient developed significantly elevated liver enzymes (peak ALT 15,463 U/L and AST 36,653 U/L), hyperbilirubinemia, oliguric renal failure, and hemolysis. A CT abdomen was obtained which demonstrated hepatomegaly with an extensive subcapsular and intraparenchymal hematoma and large volume hemoperitoneum, consistent with hepatic capsular rupture. Angiography showed extravasation of contrast from a branch of the right hepatic artery, which was embolized. The hospital course was complicated by disseminated intravascular coagulation, liver and bowel necrosis due to microthrombi requiring multiple laparotomies and resections, and persistent respiratory and renal failure. Ultimately the patient expired as a result of these complications. DISCUSSION: SLH can lead to rupture of the Glisson capsule and subsequent intraperitoneal bleeding and hemorrhagic shock. Hemodynamically stable patients can be managed conservatively. Unstable patients require hepatic artery embolization or surgical ligation, hepatic resection, or in severe cases liver transplantation. This case demonstrates a severe episode of hepatic rupture complicated by disseminated intravascular coagulation and thrombosis leading to patient mortality.

Epigastric Pain as a Potential Indicator of Hemolysis–Elevated Liver Enzymes–Low Platelet Count (HELLP) Syndrome in Pregnant Women

Epigastric pain is a common pregnancy symptom. True clinical symptoms are less evident and more challenging during pregnancy. The incidence of HELLP (hemolysis–elevated liver enzymes–low platelet count) is rare but life threatening. Liver rupture is rare and associated with a maternal mortality rate of 16.4% and a perinatal mortality rate of 31.3%. Early diagnosis and treatment have a profound effect on patients’ prognosis. Obstetric nurses should have a heightened awareness of HELLP syndrome in patients presenting with epigastric pain. Expedited interventions geared toward rapid diagnosis and treatment should be implemented to help decrease maternal and neonatal morbidity and mortality. A gravida 2 para 0 term patient presented to triage complaining of severe epigastric pain and uterine contraction for the previous 3 hours. Her cervix was closed; the fetal heart rate was tachycardic at 170 beats per minute (Category II). Intravenous therapy was begun, and a preeclampsia laboratory panel was obtained. The lab results were suggestive of HELLP syndrome. An abdominal ultrasound was performed; findings included a large subcapsular liver hematoma with right upper quadrant and perisplenic fluid. The obstetrician consulted with the trauma surgeon, and the decision was made to do an emergency cesarean and exploratory laparotomy. The patient gave birth to a viable newborn. The trauma surgeon proceeded with a laparotomy and found a large, right-lobe, subcapsular hematoma; disruption of Glisson’s capsule; and active hemorrhage from the liver. The liver was sutured; Class 3 hemorrhagic shock and disseminated intravascular coagulation were noted. The patient required multiple blood transfusions and interventions to resolve blood loss. She required two subsequent trips to the operating room and was intubated for 5 days. She recovered and was discharged home after 12 days in the hospital. Epigastric pain occurring in pregnant and postpartum patients requires diligent assessment. Epigastric pain is the most common symptom of HELLP syndrome, and it can precede abnormal bloodwork changes by several hours. Because of the life-threatening potential of HELLP syndrome, epigastric pain should always be considered a serious symptom.

Hellp syndrome complicated by subcapsular liver hematoma. a surgical emergency

Hellp syndrome complicated by subcapsular liver hematoma. a surgical emergency

Maternal and Perinatal Outcome in Patients with HELLP Syndrome

HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) is a component of hypertensive disorders of pregnancy which is associated with significant maternal as well as perinatal morbidity and mortality. Maternal mortality is due to consequences such as pulmonary oedema, renal failure, disseminated intravascular coagulation and subcapsular liver hematoma. Perinatal mortality appears to be primarily related to the gestational age at the time of delivery. This study evaluates the maternal and perinatal outcome in HELLP syndrome so that the management is improved resulting in reduced mortality and morbidity. Objectives: A. To study maternal outcome in patients diagnosed with HELLP syndrome. B. To study perinatal outcome in patients with HELLP syndrome. Methods: This study was conducted in department of obstetrics and gynaecology of medical college and tertiary health care centre. A consecutive series of 56 pregnant women above 24 weeks of gestational age with HELLP syndrome were admitted at a tertiary care hospital, during the period of 24 months from 30th November, 2015 to 31st October, 2017. History, clinical data, detailed laboratory investigations were studied and categorized by Mississippi classification for better analysis of complication and outcome in HELLP syndrome. Results: Total 56 cases of HELLP syndrome were studied. Majority of the patients were primigravidae belonging to lower socio-economic status, which were unbooked with no proper antenatal care. 60.71% of the patients had maternal complications. The complications were severe anemia in 21.43%, renal complication in 21.43%, DIC in 19.64%, abruption 14.29%, respiratory complication 7.15%, ascites 3.57% and septicemia in 3.57% and maternal mortality rate was 14.28%. A high incidence of perinatal morbidity and mortality (46.43%) was seen. Major contributing factors being prematurity, fetal growth restriction and birth asphyxia. Conclusion: HELLP syndrome is associated with increased maternal and perinatal morbidity and mortality. Once diagnosis is made, it warrants aggressive intervention with control of blood pressure, antiseizure prophylaxis and corticosteroid treatment and delivery. We have to increase grass root level antenatal care. Early detection and prompt management of pre-eclampsia is the most important approach to the prevention of HELLP syndrome.

Modified ISTH pregnancy-specific DIC score in parturients with liver rupture: population-based case series

Objectives: Liver rupture and hematoma are rare life-threatening complications of pregnancy. The aims of the current study are to: (1) characterize in a population-based study all cases of liver hematoma and/or rupture; and (2) validate the utility of the International Society on Thrombosis and Haemostasis (ISTH) modified pregnancy specific disseminated intravascular coagulation (DIC) score in those cases.Study design: A retrospective cohort study including all patients with liver subcapsular hematoma or rupture between the years 1996 and 2012 was conducted. Information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities, as well as maternal and fetal outcomes was collected. The pregnancy-specific modified ISTH DIC scores were calculated from admission to discharge, a score >26 is suggestive of DIC.Results: Out of 175,000 births in our database, seven patients were identified with liver rupture or subcapsular hematoma, representing a prevalence of 4:100,000 deliveries. Of those, six had liver rupture and one had subcapsular liver hematoma. One patient died of hemorrhagic shock. Four patients underwent surgical liver packing and one also underwent hepatic artery ligation. Four out of seven patients were diagnosed during the immediate postpartum period with severe features of preeclampsia or with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Modified ISTH pregnancy-specific DIC scores were calculated for five out of seven patients, and three (60%) had a score higher than 26. Patients with higher scores received more blood product transfusions, had longer hospitalizations, and their neonates had lower 1 and 5 minutes Apgar scores.Conclusions: Elevated pregnancy-specific modified ISTH DIC score (>26) in patients with liver hematoma or rupture was associated with adverse maternal and neonatal outcomes and appeared to perform well in distinguishing high and low-risk cases. Postpartum preeclampsia may be associated with severe features and a more complicated disease course.

Post-cesarean section rupture of subcapsular liver hematoma. A rare event should be kept in mind

The authors report a case of a 30-year-old multipara, 36-week pregnant, complicated by HELLP (hemolysis elevated liver enzymes low platelets) syndrome, with 4th repeat cesarean section. Twenty hours after cesarean section, the patient developed hypovolemic shock and hemoperitoneum and ruptured subcapsular hematoma was diagnosed by ultrasonography and confirmed by CT. Resuscitation was performed with continuous observation in ICU. After 48 hours, hemoperitoneum was evacuated by re-exploration through the same pfannensteil incision without any surgical maneuver in the liver. The subcapsular hematoma was followed and nearly disappeared after one month.

Morts maternelles par complications hypertensives. Résultats de l’enquête confidentielle française sur la mortalité maternelle, 2010–2012

Between 2010 and 2012, the rate of maternal death caused by hypertensive disorders (0,5/100,000 living birth) was reduced by 50% compared to the 2007–2009 period. Hypertensive disorders were responsible from 5% of maternal deaths and from 10% of direct maternal mortality. Eleven deaths happened during the postpartum period but 9 hypertensive complications began before delivery. Seventy percent of these deaths seem to be avoidable. The main causes of suboptimal management were: unappropriated or insufficient obstetrical and anesthetic treatments, undiagnosed HELLP syndrome and subcapsular liver hematoma, delayed treatment. The analysis of these maternal deaths gave the opportunity to stress some major lessons to optimize medical management in case of hypertensive diseases during pregnancy: abdominal symptoms during third trimester of pregnancy lead to search hypertensive disorders; HELLP syndrome with severe anemia indicate to carry out abdominal ultrasound.

Hepatic rupture as the initial manifestation of HELLP syndrome

A 34-year-old normotensive nulliparous woman at 38 weeks’ gestation developed sudden onset of severe right upper quadrant pain, fetal distress, hypotension, and a generalised seizure. At urgent Caesarean section, a ruptured subcapsular liver haematoma was found. A healthy infant was delivered. Haemostasis was obtained with a Pringle manoeuver and liver packing. Subsequent bloodwork diagnosed HELLP syndrome. Both the patient and the infant made a full recovery. This case demonstrates the effectiveness of prompt application of these surgical manoeuvres.

Morts maternelles par complications hypertensives. Résultats de l’enquête confidentielle française sur la mortalité maternelle, 2010–2012

Between 2010 and 2012, the rate of maternal death caused by hypertensive disorders (0,5/100,000 living birth) was reduced by 50% compared to the 2007–2009 period. Hypertensive disorders were responsible from 5% of maternal deaths and from 10% of direct maternal mortality. Eleven deaths happened during the postpartum period but 9 hypertensive complications began before delivery. Seventy percent of these deaths seem to be avoidable. The main causes of suboptimal management were: unappropriated or insufficient obstetrical and anesthetic treatments, undiagnosed HELLP syndrome and subcapsular liver hematoma, delayed treatment. The analysis of these maternal deaths gave the opportunity to stress some major lessons to optimize medical management in case of hypertensive diseases during pregnancy: abdominal symptoms during third trimester of pregnancy lead to search hypertensive disorders; HELLP syndrome with severe anemia indicate to carry out abdominal ultrasound.

A RARE CASE OF NATAL LIVER TRAUMA IN THE NEWBORN

This article describes the case of birth trauma with the liver subcapsular hematoma.

Diagnosis and Management of HELLP Syndrome Complicated by Liver Hematoma.

Subcapsular liver hematoma is a rare but potentially life-threatening complication of preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. It may present with nonspecific signs and symptoms, none of which are diagnostic, and can mimic pulmonary embolism of cholecystitis. There is no consensus on the management of subcapsular liver hematoma. Unruptured liver hematoma can be conservatively managed. When rupture occurs, surgical, endovascular approaches and, rarely, liver transplantation, may be required. Actual literature is scant and retrospective in nature. Data on follow-up, time to resolution and outcome of subsequent pregnancies are very limited. We here review the diagnosis and management of liver hematoma.

Subcapsular left hepatic lobe hematoma: A potentially life-threatening post-ERCP complication

Endoscopic retrograde cholangiopancreatography (ERCP) is minimally invasive procedure commonly performed for biliary and pancreatic diseases. According to literature, the most common related complication are pancreatitis, post-sphincterotomy bleeding, perforation and cholangitis. This is rare and exceptional ERCP complication and only few cases have been reported. We report a case of rare post-ERCP complication, subcapsular liver hematoma that was diagnosed 16 hour post-ERCP in 28-year-old lady with intra-abdominal collection, ultrasound guided drainage of suspected bile leak was done, but the drained fluid was bloody (blood mixed with bile), with total amount of 900 ml in the first 36 hours. Patient received 2 units packed RBCs and she maintain her vital sign and hemoglobin 8.5 g/dl. Computed tomography scan of abdomen revealed a large left hepatic lobe subcapsular hematoma 16x7x12 cm with no active bleeding causing compression of the left hepatic vessels. On the basis of laboratory, clinical, and hemodynamic parameters the patient was hemodynamically stable. She was managed conservatively with only ultrasound guided drained of abdominal collection and no any radiological or surgical intervention needed for the hematoma.

A Fatal Case of Complicated HELLP Syndrome and Antepartum Eclamptic Fit with Ruptured Subcapsular Liver Hematoma

Abstract Objective To describe a fatal case of ruptured subcapsular liver hematoma as regards diagnoses and management. Design Case report. Setting Department of Obstetrics and Gynecology. Patient A 25-year-old woman developed HELLP syndrome and antepartum eclamptic fit complicated with ruptured subcapsular liver hematoma during the 28th week of pregnancy. Intervention Midline abdominal exploratory laparotomy, with delivery by caesarean section. Tight abdominal packing for the hematoma and Pringle maneuver were done. Partial couvelaire uterus was managed by prostaglandins and B-Lynch brace sutures to minimize uterine bleeding and atony. The patient developed postoperative hepatic, renal failure, coagulopathy, deterioration and finally death. Conclusion(s) Ruptured subcapsular liver hematoma is a life-threatening condition that should be considered in pregnant women with HELLP syndrome and severe preeclampsia presenting with symptoms and signs of hemorrhagic shock, hemoperitoneum and the liver should be evaluated with ultrasound before delivery. In these patients delivery of the fetus is the first step and the best approach is a midline abdominal incision. Also, regular antenatal care is very important through all trimesters.

Safety of reducing the recovery time after percutaneous and laparoscopic liver biopsy

Abstract Background Liver biopsy is the main diagnostic tool for the study of the liver, and as such, its inherent complications have been minimised as much as possible over the years, through the modification of several factors regarding its procedure, including post-biopsy recovery time. The aim of this study was to evaluate the safety in the reduction of post-liver biopsy recovery time. Material and methods A non-blinded, randomised clinical trial was conducted in the “Hermanos Ameijeiras” Hospital from November 2011 to October 2012, on 128 patients in order to assess safety when reducing post-biopsy recovery times. The patients were randomised into 2 groups. Group A was allowed a 6-h recovery time, while Group B was allowed a 2-h recovery time after liver biopsy. Complications were fully recorded. The Chi squared test of homogeneity and Student t test was used as appropriate, in the statistical analysis, a significance level of 0.05 was set. Results The main biopsy indication was elevated plasma transaminases. Pain in the puncture site was the most recurrent complication (67.2%), and the most serious complication was subcapsular liver haematoma in two cases (1.6%). There were no differences regarding the liver biopsy technique that could have caused complications in any group. Conclusions There were no significant differences between 2 h and 6 h post-liver biopsy recovery time in terms of complications, so it is considered that after 2 h the patient is incorporated more quickly into their activities, and the institution spends less material and human resources.

Scrotal Hematoma as a Sign of Subcapsular Liver Hematoma in a Preterm Infant

a Tepecik Training and Research Hospital, Department of Neonatology, Izmir, Turkey b Sitki Kocman University, Faculty of Medicine, Department of Neonatology, Mugla, Turkey c Tepecik Training and Research Hospital, Department of Radiology, Izmir, Turkey d Dr Behcet Uz Children’s Hospital, Department of Neonatology, Izmir, Turkey e Katip Celebi University, Faculty of Medicine, Department of Neonatology, Izmir, Turkey

Liver Hematoma Presented as Midgut Volvulus Due To Medical Error: A Case Report

Introduction: The use of an umbilical catheterization is a usual practice in neonatal units. The insertion of the catheter has potential complications. Case Presentation: Here, we report on our observation of a seven-day-old female newborn admitted for an abdominal distention and vomiting bile. Initially, diagnosis was midgut volvulus, for which an operation was performed. During the surgery, no intestinal malrotation, mesenteric defect or atresia was observed. Postoperative diagnosis was abdominal wall hematoma and rand ligament and ileus, as well as, sub-capsular liver hematoma. The patient had been hospitalized at birth at a neonatal intensive care unit (NICU). With the appearance of icterus on the first day of life, at the NICU tried to insert the umbilical catheter that had been filed. Conclusions: The complication found in the patient was the result of an aggressive act (the umbilical catheter insertion). This intervention should not be carried out unless there are clear indications, and if so, it should be done with much care.

Subcapsular liver hematoma due to endoscopic retrograde cholangiopancreatography: case report

Subcapsular hematoma due to endoscopic retrograde cholangiopancreatography is a rare complication. There are only a few case reports in this subject in literature. This report’s aim is to present subcapsular hematoma due to endoscopic retrograde cholangiopancreatography case and compare it with the literature. A sixty-nine-year-old female patient was admitted to the clinic with abdominal pain and jaundice. In physical examination epigastric tenderness was present. Patient went under ERCP procedure due to choledocholithiasis. 1.5 cm of filling defect was seen in hilar region in ERCP. The gallstone was extracted with endoscopic sphincterotomy, balloon and basket. 12 hours after being discharged, patient admitted to the emergency service presenting low blood pressure, fatigue and abdominal pain. Arterial blood pressure and heart rate was respectively 90/60 mmHg and 100 bpm. Abdominal examination presented tenderness, guarding and rebound in all quadrants. Ultrasonography and general abdominal computed tomography showed subcapsular liver hematoma and subdiaphragmatic free air. The patient was operated due to acute abdomen. During exploration, laceration and subcapsular hematoma was present on the anterior face of the right lobe. Lacerated area was sutured simply. Postoperative day 9 patient was discharged with no complications. Patient was admitted presenting fever and abdominal pain postoperative month 1. USG and CT revealed that an approximately 10x3 cm heterogenic collection adjacent to the left lobe of the liver was reaching out to epigastrium. Percutaneous drainage was performed. Drainage was continued for 1 week. Control USG revealed regression and drainage was terminated. No complications were observed in patients 1 year of follow-up. Subcapsular hematoma of the liver is a rare complication. It should be considered in case of sudden hypotension and abdominal pain after ERCP. Conservative treatment should be considered in the foreground, however, surgery should be scheduled in case of acute abdomen and/or hemodynamic instability.