Subcapsular Liver Hematoma Research Articles

Two Rare Cases of Intrahepatic Subcapsular Hematoma After Laparoscopic Cholecystectomy

The appearance of subcapsular liver hematoma after a laparoscopic cholecystectomy (LC) is an infrequent complication and seldom studied. Some cases have been connected to ketorolac given during surgery and after surgery. Other described causes are : hemangiomas or small iatrogenic lesions that could be aggravated by administration of ketorolac. Coagulation dysfunction like circulating heparin as seen in hemathological diseases is cause of bleeding after aggressive procedures. We describe two cases of subcapsular liver hematoma after LC, both of them have been given intravenous ketorolac and one of them had multiple myeloma. We discuss the causes and treatment of it.

Manifestation of dynamic contrast-enhanced CT of hepatic injury in rabbits

Objective To analyze the features of dynamic contrast-enhanced CT of blunt hepatic injury in rabbits. Methods The model of blunt hepatic injury was established in 40 New Zealand white rabbits with a steel ball falling down to the xiphoid process of the animals. Plain CT scan and dynamic contrast-enhanced CT scan (Hispeed spiral CT/2i, GE, America) of the liver were performed. Arterial,portal and balanced phases were respectively at 8-10 s, 35-40 s and 120-150 s after initiation of the contrast medium injection. The non-enhanced and enhanced images were compared in aspects of location and range of injury, tear of the liver capsule, active bleeding, involvement of the main hepatic veins and CT features of abdominal hemorrhage, which was further compared with the results of gross anatomy. Results The rate of plain CT scan was obviously lower than that of dynamic contrast-enhanced CT scan,which defined single tear in 13 patients, multiple lacerations in 18, liver subcapsular hematoma in seven,liver hematoma in nine, liver coated gap in 17, active bleeding in nine and main hepatic vein injury in five, with coincidence rates with the results of gross observation for 13/13,18/18,7/9,9/9,25/30,9/5and 5/4 respectively. According to Moore' s classification, CT/Laparotomy performed from grade Ⅰ to grade Ⅵ were 5/4 patients at grade Ⅰ , 15/13 at grade Ⅱ, 9/11 at grade, 5/6 at grade Ⅳ, 1/2 at grade Ⅴ, O at grade respectively. Conclusion Dynamic contrast-enhanced CT scan, especially at portal and balanced phases, is of great value for diagnoses of liver injuries and determination of injury severity. Key words: Liver; Wounds,nonpenetrating; Rabbits; Dynamic contrast-enhanced; Tomography,X-ray computed

Radiofrequency ablation of renal tumors: Practical aspects and results

ObjectivesTo report our experience in percutaneous radiofrequency ablation of renal tumors, emphasizing technical aspects and indications and analyzing our results. Material and methodsWe retrospectively analyzed 20 tumors in 13 patients (10 with a single kidney, 2 who had refused surgical treatment, and 1 with severe comorbidities). All procedures were performed using the radiofrequency interstitial tumor ablation (RITA) technique under general anesthesia and CT guidance. All patients underwent follow-up CT examination with and without intravenous contrast administration; the absence of enhancement was considered complete necrosis. ResultsThe mean size of the tumors was 2.8cm. Complete necrosis was achieved in 17 tumors (85%); complete necrosis was achieved in 100% of the exophytic tumors and in 50% of the tumors with mixed location after 14 months’ follow-up. Complete ablation was achieved in 15 of the 16 tumors measuring ≤ 3.5cm. In 9 of the 10 patients with a single kidney (four of whom had more than one tumor), renal function remained normal after the procedure; the other patient developed hydronephrosis after a urinary tract lesion and died. The patient who died also developed a subcapsular liver hematoma that did not require transfusion when another tumor was treated transhepatically. ConclusionIn experienced hands and with careful selection of patients (exophytic tumors ≤ 3.5cm), radiofrequency ablation of renal tumors can achieve excellent oncologic results with minimal morbidity and mortality.

Complications of Laparoscopic Cholecystectomy: Our Experience in a District General Hospital

Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic gallstone disease. Some of the associated complications are rare, but often serious. The purpose of this study is to present our data about the type and the incidence of these complications and our experience in their management, in a district hospital, during the last 8 years. A retrospective study was performed on 1009 patients, 229 males and 780 females, with age ranging from 19 to 84 years, who underwent laparoscopic cholecystectomy for symptomatic gallstone disease, during the period from January 2000 to January 2008. The procedure was performed urgently due to acute cholecystitis in 78 patients (7.73%). Complications occurred in 96 (9.51%) patients. Bile leakage occurred in 15 patients (1.49%). One patient (0.10%) had a major bile duct injury (common bile duct transection). Bleeding occurred in 9 patients (0.89%), wound infection in 14 patients (1.39%), abdominal wall hematomas in 3 patients (0.30%), omental hematoma in 3 patients (0.30%), port site hernias in 3 patients (0.30%), subphrenic abscess in 1 patient (0.10%), subcapsular liver hematoma in 1 patient (0.10%), bowel injury in 5 patients (0.51%), postoperative acute pancreatitis in 4 patients (0.40%), respiratory and cardiovascular complications in 11 patients 1.09%). Finally in 14 patients (1.39%), the gallbladder was unintentionally opened during laparoscopic procedure and spillage of gallstones occurred into the peritoneal cavity. All patients had satisfactory results and no death occurred. We conclude that laparoscopic cholecystectomy is a safe procedure, although it is associated with some serious complications. The most usual complication during laparoscopic cholecystectomy is bile leakage, which remains a significant cause of morbidity. Early identification and management of these complications will minimize a potentially devastating outcome.

Hematoma subcapsular por Fasciolasis

Liver subcapsular hematoma caused by Fasciola hepatica. Report of one case We report a 60 years old female admitted for pain in the right upper quadrant of the abdomen, vomiting and fever. Initial laboratory showed leukocytosis with 56% of eosinophils. An abdominal CAT scan showed a subcapsular fluid collection in the liver. The patient was operated and the presence of a subcapsular hematoma was confirmed. Blood serological tests were positive for Fasciola hepatica. The patient was treated with tricabendazole and after one year of follow up, is in good conditions.

Prise en charge du HELLP syndrome

Defined by the association of hemolysis, hepatic dysfunction and thrombocytopenia, the Hemolysis, Elevated Liver enzyme, Low Platelets (HELLP) syndrome can complicate preeclampsia and worsen maternal and fetal prognosis. It can be diagnosed in the immediate postpartum (30%) or in the absence of preeclampsia (10–20%). Clinical diagnosis can be difficult because there is no specific symptom. Abdominal pain or vomiting during the third trimester must lead to think about this diagnosis. Biological criteria are well defined: hemolysis by the presence of schistocytes, increased serum total bilirubin > 12 mg/L or LDH > 600 IU/L, hepatic dysfunction by increased transaminases and thrombocytopenia by a platelet count < 100 000/μL. The evolution of those parameters is a major prognostic factor. With the HELLP syndrome, maternal morbidity is dramatically increased compared to isolated preeclampsia with complications such as eclampsia, placental abruptio, disseminated intravascular coagulation, pulmonary edema, acute renal insufficiency, subcapsular liver hematoma. The management of a HELLP syndrome requests level 3 hospital with intensive care units for neonate and mother. The treatment of this syndrome requires termination of the pregnancy as soon a possible, either by cesarean section or by vaginal delivery if cervical conditions are optimal (without any maternal or fetal complications). Before 32 weeks, a more expectative attitude could be acceptable with the prematurity permitting corticotherapy for fetal pulmonary maturation. This corticotherapy can improve temporary biological parameters but there are no proven benefits to consider improvement for long term maternal or fetal prognosis. During the postpartum, evolution is usually spontaneously favorable. Recurrences are not frequent.

Three‐dimensional ultrasound diagnosis of ruptured subcapsular liver hematoma caused by HELLP syndrome

Three‐dimensional ultrasound diagnosis of ruptured subcapsular liver hematoma caused by HELLP syndrome

A case of delayed hemorrhage of a subcapsular liver hematoma in a neonate

A subcapsular liver hematoma (SLH) is a relatively common lesion in fetuses and neonates. Although an SLH ruptures rarely, it may be life threatening. We report on a term neonate with a delayed rupture of an SLH that occurred on day 7 of life. The infant had been resuscitated with intubation, positive pressure ventilation, and chest compression at birth because of meconium-associated perinatal depression. The SLH was diagnosed by abdominal ultrasonography and paracentesis, and the ruptured SLH was treated operatively. After intensive medical and surgical management, the infant was discharged healthy on day 27 of life. A newborn infant presenting with the sudden onset of extreme shock and pallor associated with abdominal distension should undergo differential diagnosis for SLH and a clinical evaluation concurrent with fluid resuscitation and timely surgery.

Subcapsular liver haematoma after cardiopulmonary resuscitation by untrained personnel

Although early cardiopulmonary resuscitation (CPR) is associated with increased survival of sudden cardiac arrest victims, it may also result in miscellaneous injuries. A 25-year-old inebriated man rescued from drowning in a swimming pool was apnoeic and pulseless after being pulled out of the water. Successful CPR was provided by untrained bystanders, including abdominal thrusts thought to remove water from the airways and chest compressions to provide haemodynamic support. As the patient progressively improved during his subsequent hospital stay, he complained of right upper abdominal and thoracic pain. A computed tomographic scan showed a 11 cm subcapsular haematoma contiguous to the right hepatic lobe. A favourable outcome was obtained after conservative, non-operative treatment. Subcapsular haematoma of the liver is a potentially life threatening complication that warrants consideration in survivors of cardiac arrest who have received closed chest compression and/or abdominal thrusts.

Rupture du foie en péripartum: à propos de huit cas

Subcapsular liver hematoma (SLH) is a serious complication of the preeclampsia and HELLP syndrom. We report eight cases, and we'll precise circumstances of occurrence of this complication, its management and its prognosis. Between January 2000 and December 2005, we enrolled eight patients with SLH cases in the intensive care unit of maternity's Ibn Rochd university hospital in Casablanca, Morocco. The patients are 22 to 41-years-old; six are multiparous, without prenatal care. All are preeclamptic. We diagnosed the SLH in prepartum stage in one case, in operating room in five cases and in post partum stage in two cases. We established blood pressure and homeostasis disturbances, the surgeon made packing for six patients with hepatic artery ligature in two cases. In two other patients, we did only medical care. We noted five deaths, four after hematoma rupture. These results were compared with literature, we need to look for this complication in all-severe preeclampsia with HELLP syndrome, and treat all haemostatic disorders.

Spontaneous rupture of the liver in a patient with chronic hepatitis B and D

Spontaneous rupture of the liver is a rare condition with serious consequences, if not recognized and treated in time. It has been reported as a complication of several disorders, including benign or malignant liver tumors, connective tissue disease, infiltrating liver disease, preeclampsia, and post anticoagulant therapy. We report a case of spontaneous rupture of liver in a non-cirrhotic, chronic hepatitis B and D patient presenting with acute hemoperitoneum and shock. The subcapsular hematoma and rupture of liver were documented by image studies. The patients' condition gradually stabilized after fluid resuscitation. The reported case and literature review suggest that spontaneous rupture of liver must be considered in a differential diagnosis of acute hemoperitoneum. A high index of suspicion and early diagnosis with imaging are critically important.

Fatal outcome following foetal cerebellar haemorrhage associated with placental thrombosis

Cerebellar haemorrhage is a rare prenatal event. Possible aetiologies for foetal intracranial haemorrhage include: trauma, asphyxia, infection, vascular defects, blood dyscrasias, ingestion of drugs and alloimmune and isoimmune thrombocytopenia. We report the ultrasonographic diagnosis of a cerebellar haematoma at 21 weeks of gestation. The foetus succumbed at 33 weeks of gestation following rupture of a subcapsular liver haematoma. An autopsy demonstrated a placental foetal thrombotic vasculopathy and thrombi in the chorionic vessels. We assume that hypercoagulability was responsible for the multiple infarcts in the foetus with haemorrhagic transformation in the cerebellum and liver. The differential diagnosis of foetal cerebellar haemorrhage includes maternal hypercoagulability; in this case multiple haemorrhagic/ischaemic events may be encountered during the pregnancy. A thorough investigation to elucidate the aetiology is pertinent in every case of foetal cerebellar haemorrhage in order to enable accurate counselling and correct management.

Subcapsular Hematoma of the Liver After Laparoscopic Cholecystectomy

Two female patients underwent an uneventful laparoscopic chloecystectomy (LC) for cholelithiasis. Their past medical history was insignificant. The first patient had diclofenac sodium for her postoperative pain relief. Both patients returned in the early postoperative period with pain in the right hypochondrium. Laboratory investigations revealed elevated leucocytes, C reactive protein (CRP), and deranged liver function tests. A computed tomography (CT) scan showed subcapsular haematoma of liver. CT-guided aspiration of hematoma was done in one case. Both patients improved over a period of time and a follow-up radiological scan showed resolving hematoma. The presentation, diagnostic evaluation, treatment, and possible causes are discussed.

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.

A case report of a low-birth-weight infant with a subcapsular liver hematoma and spontaneous bowel perforation

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Ruptured subcapsular liver hematoma in pregnancy: a case report of nonsurgical management

Ruptured subcapsular liver hematoma in pregnancy is a rare condition that is usually managed surgically. Recently, however, surgical and obstetric literature has discussed conservative management. We describe successful conservative management of ruptured subcapsular liver hematoma in a woman with preeclampsia who had hemoperitoneum seen at cesarean section.

Imaging of subcapsular liver hematoma and hepatic infarction in pregnancy complicated by the HELLP syndrome: a case report

We report the case of a 40-year-old woman, who had extensive hepatic necrosis, multiple liver infarctions, subcapsular liver hematoma, acute renal failure, and massive ascites in the setting of hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP) syndrome in the post-partum period. Our purpose was to describe the effects of serious obstetric complications on maternal and perinatal outcome in pregnancies complicated by HELLP syndrome and the role of radiological findings in the diagnosis and course of the patient. We describe a patient who had abnormal sonographic findings of the liver immediately post-partum before signs and symptoms of severe preeclampsia and HELLP syndrome. The abnormal sonographic appearance of the liver prompted further investigation and was instrumental in the management of this case. These serious hepatic complications can be initially detected by ultrasonography. In addition, computed tomography of the abdomen confirmes the diagnosis and delineates the lesions more precisely. Moreover, ultrasonography can be used as a screening imaging modality compare to computed tomography and magnetic resonance imaging.

Subcapsular liver hematoma in HELLP syndrome: Evaluation of diagnostic and therapeutic options—A unicenter study

Objective Subcapsular liver hematoma formation has been reported in less than 2% of pregnancies complicated by HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. The purpose of this study was to identify the main diagnostic and therapeutic options for management of these patients. Study design In this 10-year retrospective review, we performed a computer-directed search of all cases of confirmed HELLP syndrome with hepatic hematoma treated in the surgical department of our tertiary care referral medical center. Results Five patients with subcapsular liver hematoma in HELLP syndrome could be identified. All patients received transabdominal ultrasound, computed tomography, or magnetic resonance imaging. Conservative treatment was successful in three patients. Emergency surgical intervention was necessary in two patients, including one liver transplantation. Conclusion The case series shows the full diagnostic spectrum with transabdominal ultrasound, computed tomography, and magnetic resonance imaging, as well as the different therapeutic options varying from conservative therapy to operative management, including liver transplantation.

Spontaneous subcapsular liver hematoma associated with pregnancy.

Spontaneous subcapsular liver hematoma associated with pregnancy.

Complicaciones y rendimiento de la biopsia hepática percutánea con marcado ecográfico

To describe the complications and the diagnostic yield of percutaneous liver biopsies performed under ultrasonographic control in an Internal Medicine department. A total of 750 percutaneous liver biopsies were performed at the Internal Medicine department of our institution during the 1995-2001 time period. The Menghini technique was employed previous ultrasonographic marking of the puncture site was performed by the same physicians who performed the biopsy. Major and minor complications as well as the diagnostic yield (obtention of diagnostic hepatic tissue) of the technique were recorded. No deaths occurred in our series. Two patients (0.3%) had major complications presenting as liver subcapsular hematoma with hemoperitoneum which resolved with conservative measures. One of them was a male patient with acute leukemia and the other was a woman on antiaggregant therapy. Eight patients (1.1%) had minor complications (vasovagal syncope), all of them young males. In three cases no adequate material for diagnosis was obtained (technique yield 99.6%). In our series, percutaneous liver biopsy with ultrasonographic marking is a diagnostic technique associated with a low rate of severe complications and with a high diagnostic yield. The use of ultrasonographic marking by the same physicians performed the biopsy does not involve a longer time or increased cost of the technique, provides more safety in the procedure and has a low morbidity rate. This procedure could be used on a routine basis for all percutaneous liver biopsies.