Chronic expanding hematoma of the liver: a case report and review of the literature

Chronic expanding hematoma (CEH) is defined as a hematoma that grows slowly over a month or longer. CEH with a primary hepatic origin is extremely rare. An 85-year-old man presented with general malaise and low-grade fever. His medical history included hypertension and postoperative appendicitis, and he was taking oral aspirin. Computed tomography showed a 7-cm mass in liver S7 with calcification at the margin. On contrast-enhanced magnetic resonance imaging, the inside of the mass showed heterogeneous hyperintensity on T1-weighted images, mainly low intensity on T2-weighted images, and mild hyperintensity in some areas. Under the preoperative diagnosis of suspected CEH, hemorrhagic cyst, or hepatocellular carcinoma, S7 partial liver resection and cholecystectomy were performed. Histopathological findings showed that the mass was continuous with the liver and protruded extrahepatically, and was covered with a hard fibrous capsule. The capsule contained hematomas ranging from obsolete to relatively fresh, with no neoplastic lesions. He was diagnosed with CEH in the liver. This subcapsular hepatic hematoma was pathologically shown to be a CEH. Complete surgical resection was effective in treating this CEH in the liver.

Laparoscopic cholecystectomy after conservative subcapsular hepatic hematoma management: A rare case report

INTRODUCTION AND IMPORTANCE

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a less invasive procedure to diagnose and treat biliary disease. However, it has a mortality rate of 0.43-1 %. ERCP has several complication that can arise, one of which is a subcapsular hepatic hematoma (SCH). Incidence of subcapsular hematoma is about 1 %.

CASE PRESENTATION

In this case we reported a 33-years-old female complained of jaundice in the entire and right upper abdominal pain. She underwent ERCP and stent placement due to an obstruction in the biliary system. The day after ERCP, she has complained about persistent sharp pain on the upper abdomen. Abdominal ultrasound showed SCH. She then underwent laparoscopic diagnostic and showed the hematoma at the subcapsular of the right upper lobe.

CLINICAL DISCUSSION

Then it was decided to conservative therapy with an antibiotic and analgesics. Cholecystectomy was also performed to treat cholelithiasis. Patient discharge from hospital in three days after surgery with a good condition and no symptom about stomachache.

CONCLUSION

Conservative treatment is the goal while managing SCH in a good hemodynamic state. Once a hematoma has been identified, treatment with a broad-spectrum antibiotic should be started since the hematoma may turn into a secondary infection that requires invasive techniques and drainage.

Subcapsular hepatic hematoma as a complicating cardiac surgery

An 80-year-old woman was hospitalized for aortic valve insufficiency, paroxysmal atrial fibrillation, and ascending aortic aneurysm. She underwent aortic valve replacement, pulmonary vein isolation, left atrium appendectomy, and ascending aorta replacement. She developed a subcapsular hepatic hematoma during the surgery. The patient was managed conservatively and discharged successfully.

Subcapsular Hepatic Hematoma Post-Endoscopic Retrograde Cholangiopancreatography Requiring Surgical Necrosectomy

Cholelithiasis is a common gastrointestinal pathology with a prevalence of over 6% in the USA. Symptomatic patients can develop cholangitis, biliary colic, pancreatitis and cholecystitis. Surgical management involves laparoscopic or open cholecystectomy. Stones within the common bile duct can be treated with endoscopic retrograde cholangiopancreatography (ERCP). Well-known ERCP complications include pancreatitis, perforation, bleeding and cholangitis. Hepatic hematomas as a complication of ERCP are extremely rare, with fewer than 50 reported cases in the literature. Approximately 22% have required operative management. We present an extremely rare case of ERCP-associated subcapsular hepatic hematoma in a 43-year-old lady that was initially non-operatively managed. She did not improve with antibiotics alone and underwent attempted interventional radiology drainage. Despite this, due to on-going sepsis, the patient underwent laparoscopic necrosectomy and drain placement with continued post-operative irrigation. After a long course of antibiotics and drain irrigation, the patient was discharged with repeated computed tomography imaging showing almost total resolution of the infected collection. This case highlights the extreme rarity of surgical management for post-ERCP subcapsular hepatic hematoma and its successful outcome.

Subcapsular hepatic hematoma: a case of chronic expanding hematoma of the liver

Background

A chronic expanding hematoma (CEH) enlarges as a result of slight bleeding over several months, and the tissue shows a mixture of blood breakdown products, granulation tissue with capillary ingrowth, and inflammatory tissue. This report presents a case of a subcapsular hepatic CEH that was treated with transarterial embolization (TAE) and hepatectomy.

Case presentation

A 56-year-old man presented with vomiting and right-sided abdominal pain. Plain abdominal computed tomography (CT) showed a high-density area of fluid collection beneath the capsule of the right hepatic lobe, which was diagnosed as a hematoma. From its anatomical position on the CT images, a subcapsular hepatic hematoma was diagnosed. Though conservative therapy was provided, CT-guided percutaneous drainage and TAE were performed due to worsening symptom. Because the patient's abdominal symptoms re-appeared, extended right segmentectomy including the hematoma was performed. In the resected specimen, the hematoma was located beneath the capsule of the right hepatic lobe, and it was displacing the hepatic parenchyma. Microscopic examination showed a thick fibrous capsule around the hematoma, peripheral lymphocyte and plasmacyte invasion, and aggregations of histiocytes containing phagocytosed hemosiderin.

Conclusions

Anatomically, this was a case of a subcapsular hepatic hematoma, and pathologically it was shown to be a CEH. Complete surgical resection was effective treatment for this CEH.

Interventional Management of Subcapsular Hepatic Hematoma with Hepatic Compartment Syndrome After Laparoscopic Adrenalectomy

Hepatic compartment syndrome is an increase in intrahepatic pressure sufficient to cause compromised hepatic perfusion. Early recognition and prompt management are essential for preventing catastrophic consequences including ischemic liver failure and hypovolemic shock. This is the rare case of laparoscopic adrenalectomy resulting in subcapsular hepatic hematoma with hepatic compartment syndrome. Contrast-enhanced computed tomography demonstrated extensive subcapsular hepatic hematoma with collapse of portal vein and inferior vena cava suggesting impending compartment syndrome. Diagnostical catheter angiography of the liver revealed innumerable foci of petechial extravasation from disrupted isolated arteries. Emergent percutaneous catheter decompression and transarterial embolization were successful.

Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review

Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients’ haemodynamic and clinic.