The development of subcapsular hepatic hematoma after ercp is a rare complication with only 4 cases reported in the literature 1,2. Herein, we reported a rare giant ish after lc and summarized all of the reported cases. Treatment of subcapsular haematoma, a complication of. The appearance of subcapsular liver hematoma after a laparoscopic cholecystectomy lc is an infrequent complication and seldom studied. Pdf subcapsular liver haematoma as a complication of. The block was performed four times for 4 weeks at the level of l3 using a lossofresistance method, with a 15cm 20g needle and 10 ml 1% lidocaine.
Hematoma subcapsular intraparenquimatoso hepatico roto, una rara complicacion post colangiopancreatografia retrograda endoscopica. In a case described in the literature, subcapsular haematoma developed a week after removal of the gallbladder. Subcapsular liver hematoma slh is a rare complication of severe preeclampsia and hellp syndrome. Subcapsular hematoma of the liver after laparoscopic. Subcapsular liver hematoma after endoscopic retrograde. Subcapsular hepatic hematoma is a rare and little reported complication post ercp resulting in significant morbidity. Atypical hemolytic uremic syndrome ahus is a rare, lifethreatening systemic in. Hepatic subcapsular hematomas in fetuses and neonatal infants. Hi all, i just got a report from my endocrinologist after trying to find a few answers to some ongoing health concerns that seemed hormonal but it looks like they might not be after all. A 32year old woman with recurrent acute cholecystitis for one year, underwent elective lc without intra.
Early recognition and prompt management are essential for preventing catastrophic consequences including ischemic liver failure and hypovolemic shock. Interventional management of subcapsular hepatic hematoma. If the patient has a more severe liver injury or is not stable, surgery will be required. Intrahepatic subcapsular hematoma ish is an extremely rare, lifethreatening complication after laparoscopic cholecystectomy lc. Muestra imagen tubular con abundantes grumos en su interior y material ecogeno en su interior, con refuerzo ecogenico posterior. The postulated mechanism by which occurs is an accidental puncture of the guidewire into the intrahepatic biliary tree 6. A high index of suspicion is essential for early identification and stabilisation of babies with such a pathology. We report an unusual case of left hepatic lobe subcapsular hematoma after ercp presenting with a drop in hemoglobin, tachycardia and intraabdominal collection. Hypertension, clotting disorders, previous history of eswl, advanced age 60 years, diabetes mellitus, generalized arteriosclerosis, coronary artery disease, obesity and small kidney are proposed as significant risk factors 2, 3. These patients must be followed up in intensive care unit for advanced medical support with infused fluid, replacement of blood products, and treatment of underlying disorders. Rupture of subcapsular liver haematoma during pregnancy is rare, with an incidence ranging from 1. Hepatic subcapsular haematoma in a premature newborn bmj. In a newborn with hypovolemic shock and abdominal distension.
Hepatic injury is a common sequela to blunt abdominal trauma and presents a diagnostic and therapeutic challenge. Subcapsular liver haematoma as a complication of laparoscopic cholecystectomy july 2015 videosurgery and other miniinvasive techniques wideochirurgia i inne. A wide spectrum of infectious and inflammatory diseases can affect the hepatic capsular and subcapsular regions by way of peritoneal, hematogenous, biliary, and perihepatic ligamentous routes. Case discussion the patient underwent usguided drainage of the abscess and recovered well, albeit slowly. Hellp syndrome complicated by subcapsular hematoma of.
It therefore makes it imperative for these patients to be followed up in intensive care unit for advanced medical support with fluid and electrolyte management, replacement of blood products, and treatment of underlying disorders. A rare intrahepatic subcapsular hematoma ish after. This is a pdf file of an unedited manuscript that has been accepted for publication. A case with subcapsular hematoma of the liver following. Subcapsular hepatic hematoma after ercp endoscopic retrograde. Subcapsular hepatic hematoma, an extraluminal hemorragic. Subcapsular liver hematoma hepatic subcapsular hematoma. Hepatic hematoma is a rare but possible complication of ercp. Large subcapsular hepatic collection containing fluid and gas in the right lobe of the liver segments 5 and 8 in keeping with an abscess.
Hepatic subcapsular hematoma and neonatal hemophilia. Pdf we present a clinical case of a 83 years old man, who consulted to the emergency department by continuous pain in right upper quadrant, having. In this case, the patient was considered to be clinically unstable, showing signs. Hematoma subcapsular intraparenquimatoso hepatico roto. A 55 yearsold woman cholecystectomy years before was admitted to our hospital with right upper abdominal. Posteswl perinephric haematoma is a rare complication, with an incidence rate of 0.
The physical examination revealed cutaneomucose paleness and abdominal pain in right flanck on palpation. We report the case of a 42 yearold man who underwent. Intrahepatic subcapsular haematoma ish is a rare and potentially lifethreatening complication of lc. It is a catastrophic condition that can be caused by maternal, placentar or fetal factors. Because she was apyrexial and hemodynamically stable, she was conservatively managed with a broadspectrum antibiotic and gradually recovered. Surgical management of such patients is less clearly defined.
Postercp hepatic subcapsular hematoma, from conservative therapy to emergency surgery. A hepatic subcapsular hematoma in a neonate shows a nonspecific presentation such as the presence of an abdominal mass without symptoms of hemorrhage and is clinically less distinguished as compared to cases detected during an autopsy. Certain areas of the globe are considered highly endemic, including central and south america, asia. Subcapsular hepatic hematoma is an extremely rare complication of ercp, but the occurrence of abdominal pain after ercp should raise the suspicion of this complication. The goal of surgery is to stop the bleeding to stabilize the. Postursl subcapsular hematoma was diagnosed in 4 of 1114 0. Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. We present the case of a 52yearold woman with a history of recurring upper abdominal pain and a clinical and ultrasonographic diagnosis of obstructive jaundice due to common bile duct stones. An incidentally detected hepatic subcapsular hematoma in a. Rupture of subcapsular hematoma of liver in severe. Although early abdominal exploration usually is recommended when hepatic injury is suspected, a few patients will experience subcapsular hematoma without laceration. Here we report a case with postoperative subcapsular hematoma of the liver after lc.
A 55 yearsold woman cholecystectomy years before was admitted to our hospital with right upper abdominal discomfort. The spleen, kidneys apart from right superior pole cortical scar, pancreas, duodenum, gbbile ducts adrenals have normal appearances. Spontaneous retroperitoneal and subcapsular liver hematoma. Contrast materialenhanced ct scan shows a lentiform fluid collection and indentation of the underlying liver margin arrow. On the 2nd post operative day the patient began to complain about abdominal pain in right flank. A 71yrold, 47kg, 155cm woman received right lpb for treatment of low back pain associated with a herniated lumbar disc l3l4 and l4l5. Both patients returned in the early postoperative period with pain in the right hypochondrium. Here we report a case of a 32yearold primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. However, the low back pain became more intense 1 day after the last lpb, and she. The subcapsular hematoma is a serious complication, with high risk of maternal and neonatal mortality, it is seen as a complication of hypertensive diseases more frequently, busides another. Postendoscopic retrograde cholangiopancreatography ercp subcapsular hematoma usually results from an accidental puncture of the intrahepatic biliary tree and microtrauma during cannulation with. Subcapsular hematoma after ureteroscopy and laser lithotripsy.
The occurrence of pseudoaneurysm is considered a risk factor. A subcapsular hematoma appears as a lowattenuation, elliptic collection figure 1. Subcapsular lesion of the liver gastroenterology medhelp. Thus, it was released a puncture in the 8th intercostal space at the axillary medium line level. Subcapsular liver hematoma as a complication of an. I had a ct thorax to rule out the recurrence of a benign thymic tumor that i had removed years ago, and. Socas macias, m camacho marente, v barranco moreno. Subcapsular hematoma of the liver in infants of very low birth weight. The liver capsule is not visible at ct or mr imaging under normal conditions. The diagnostic contribution of ct, us and ceus the change of the therapeutic management in abdominal hemorrhages, from an invasive approach towards a nonsurgical one, an aspect which has presented an increased. Renal subcapsular hematoma after lumbar plexus block. Hematoma hepatico post colangiopancreatografia retro.
Subcapsular biloma in a 54yearold man with bile duct cancer. Biloma subcapsular hepatico secundario a colecistectomia laparoscopica. However there have been some complications peculiar to lc. Preoperative imaging showed that all four patients had obstructing proximal ureteral stones ranging in size from 0. The management of ish is dependent on the patients clinical status and the size of the haematoma. Liver segment 7 subcapsular area, measuring 6mm in depth. Laboratory investigations revealed elevated leucocytes, c reactive protein crp, and deranged liver function tests. Subcapsular hepatic hematoma after endoscopic retrograde.
Fascioliasis is a foodborne transmitted zoonosis caused by the liver trematode f. Subcapsular hematoma of the liver due to intercostal. The case is presented of a 25 year old patient with choledocholithiasis and cholelithiasis, who developed a. In pregnancies complicated with hypertension, liver. Two rare cases of intrahepatic subcapsular hematoma after. A case report of a lowbirthweight infant with a subcapsular liver hematoma. Hepatic compartment syndrome is an increase in intrahepatic pressure sufficient to cause compromised hepatic perfusion. Subcapsular hepatic hematoma secondary to endoscopic retrograde cholangiopancreatography is a rare complication, but is potentially lifethreating. Additional bleeding complications result from lesions of the spleen or the duodenal wall or colon caused by unusual movements of the endoscope with traction on the abdominal vessels 416. A neonate was delivered by vaginal delivery after 29 weeks and three days gestation with breech presentation. Ctguided aspiration of hematoma was done in one case. Laparoscopic treatment of a hepatic subcapsular abscess. Selective angiography identified the presence of pseudoaneurysm in the right hepatic artery.
A 34yearold female underwent lc for uncomplicated cholelithiasis. Case a 54yearold man with a past history of decompensated cirrhosis secondary to hepatitis c and alcohol abuse. Subcapsular hepatic abscess post laparoscopic cholecystectomy. A subcapsular hematoma of the liver is an accumulation of blood between glissons capsule and the liver parenchyma. Rare unexpected postercp complication such as subcapsular hepatic hematoma was firstly described in 2000. This is the rare case of laparoscopic adrenalectomy resulting in. Although it is rare and potentially lifethreatening condition after ercp. Hematoma subcapsular intraparenquimatoso hepatico roto, una. Subcapsular hepatic hematoma following endoscopic retrograde cholangiopancreatography. Some cases have been connected to ketorolac given during surgery and after surgery.
Rare unexpected postercp complication such as subcapsular hepatic hematoma was firstly described in 2000 4. Hepatic capsular and subcapsular pathologic conditions. Postercp pancreatitis, perforation, cholangitis and postsphincterotomy bleeding are the most frequently described complications 2, 3. A computed tomography ct scan showed subcapsular haematoma of liver. Case report guido contreras tamayo, francisco javier buenrostro perez. A 78yearold woman was admitted with acute cholecystitis due to cholecystolithiasis.
Postpartum spontaneous subcapsular hepatic hematoma. There are a lot of therapeutic options varying from conservative management to surgical. Subcapsular haematoma of the liver rarely occurs in neonates and the diagnosis is often missed or delayed. Endoscopic retrograde cholangiopancreatography ercp, subcapsular hepatic hematoma, liver transplantation, bile leak, biliary complications. Post ercp bleeding complications are rare and mainly postsphincterotomy. After 2 difficult endoscopic biliary procedures, common bile duct stones clearance was obtained.