SUBCAPSULAR LIVER HEMATOMA – A COMPLICATION AFTER  LAPAROSCOPIC CHOLECISTECTOMY

Adriana  Tudorache; M.  Bica; Larisa  Săndulescu; M.  Lazăr

doi:10.33695/rojes.v2i1.23

Adriana Tudorache General Surgery Department, Emergency County Hospital of Craiova
M. Bica General Surgery Department, Emergency County Hospital of Craiova & University of Medicine and Pharmacy of Craiova
Larisa Săndulescu University of Medicine and Pharmacy of Craiova & Research Center of Gastroenterology and Hepatology, Craiova, Romania
M. Lazăr University of Medicine and Pharmacy of Craiova

DOI: https://doi.org/10.33695/rojes.v2i1.23

Keywords: subcapsular liver hematoma, laparoscopic cholecistectomy, complication

Abstract

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.

References

[1]Naumowicz E, Białecki J, Kołomecki K. Results of treatment of patients with gallstone disease and ductal calculi by single-stage laparoscopic cholecystectomy and bile duct exploration. Videosurgery Miniinv. 2014;9:179–89.
[2]Bitner M, Jaszewski R, Jander S, Maciejewski M. Laparoscopic cholecystectomy delayed by complicated myocardial infarction with papillary muscle rupture, and performed after unique complex mitral repair. Videosurgery Miniinv. 2013;8:170–3.
[3]The Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med. 1991;324:1073–8.
[4]Duca S, Bala O, Al-Hajjar N, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB. 2003;5:152–8.
[5]Eslami S, Abedini L, Nouri NV, Rabiee M, Samani MK. Bile duct injury outcomes following cholecystectomy: a cross sectional study. Am J Clin Exp Immunol. 2020;9(3):53-57. Published 2020 Jun 15.
[6]Kot M, Głuszek S, Matykiewicz J, Kotucha B. Laparoscopic cholecystectomy – is it a safe operation method? Our experiences. Videosurgery Miniinv. 2006;1:113–20.
[7]Mohammadhosseini B, Shirani S. Intra-abdominal and abdominal wall haematoma from 5 mm port insertion site in laparoscopic cholecystectomy. Videosurgery Miniinv. 2011;6:164–6.
[8]Duszewski M, Szewczyk T, Mandryka Y, Modzelewski B. Rare haemorrhagic complications of laparoscopic cholecystectomy. Videosurgery Miniinv. 2009;4:131–4.
[9]Bierca J, Kowalski B, Kosim A, Zmora J. Lethal, iatrogenic complications of laparoscopic cholecystectomy. Videosurgery Miniinv. 2006;1:10–2
[10]Liu QF, Bian LL, Sun MQ, et al. A rare intrahepatic subcapsular hematoma (ISH) after laparoscopic cholecystectomy: a case report and literature review. BMC Surg. 2019;19(1):3. Published 2019 Jan 7. doi:10.1186/s12893-018-0453-9
[11]Minaya Bravo AM, González González E, Ortíz Aguilar M, Larrañaga Barrera E.. Two rare cases of intrahepatic subcapsular hematoma after laparoscopic cholecystectomy. Indian J Surg 2010; 72: 481–4.
[12]Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D, et al. Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg. 2001;25(10):1352–1356. doi: 10.1007/s00268-001-0122-4.
[13]Briggs CD, Irving GB, Mann CD, Cresswell A, Englert L, Peterson M, et al. . Introduction of a day-case laparoscopic cholecystectomy service in the UK: a critical analysis of factors influencing same-day discharge and contact with primary care providers. Ann R Coll Surg Engl 2009; 91: 583–90.
[14]Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, et al. . Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Ann Surg 1996; 224: 609–20.
[15]Strasberg SM, Hertl M, Soper NJ.. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180: 101–25
[16]de Castro SM, Reekers JA, Dwars BJ.. Delayed intrahepatic subcapsular hematoma after laparoscopic cholecystectomy. Clin Imaging 2012; 36: 629–31
[17]Corsale I, Francioli N., Rigutini M, Aloise F, Adriano Mori P, Buccianelli E. Intrahepatic subcapsular hematoma complicating laparoscopic cholecystectomy. Case report and literature review. Chirurgia 2014; : 39–41.
[18]Erstad BL, Rappaport WD.. Subcapsular hematoma after laparoscopic cholecystectomy, associated with ketorolac administration. Pharmacotherapy 1994; 14: 613–5.
[19]Vuilleumier H, Halkic N.. Ruptured subcapsular hematoma after laparoscopic cholecystectomy attributed to ketorolac-induced coagulopathy. Surg Endosc 2003; 17: 659.
[20]Bhandarkar DS, Katara AN, Shah RS. Intrahepatic subcapsular hematoma complicating laparoscopic cholecystectomy. Surg Endosc 2004; 18: 868–70.
[21]Shibuya K, Midorikawa Y, Mushiake H, Watanabe M, Yamakawa T, Sugiyama Y. Ruptured hepatic subcapsular hematoma following laparoscopic cholecystectomy: report of a case. Biosci Trends. 2010;4(6):355-358.
[22]Brown V, Martin J, Magee D. A rare case of subcapsular liver haematoma following laparoscopic cholecystectomy. BMJ Case Rep. 2015;2015:bcr2015209800. Published 2015 Jun 25. doi:10.1136/bcr-2015-209800
[23]Moloney BM, Hennessy N, O Malley E, Orefuwa F, McCarthy PA, Collins CG. Subcapsular haematoma following laparoscopic cholecystectomy. BJR Case Rep. 2016;3(2):20160118. Published 2016 Dec 23. doi:10.1259/bjrcr.20160118
[24]Okumus M, Ezberci F, Kuzhan N, Pircanoglu EM, Bozkurt S. A rare cause of dyspnea in a patient presenting to the emergency department: a case report and review of the literature of laparoscopic cholecystectomy complication. J Clin Med Res. 2011;3(5):262-264. doi:10.4021/jocmr664w
[25]Hansen AJ, Augenstein J, Ong ES. Large subcapsular liver hematoma following single-incision Laparoscopic cholecystectomy. JSLS.2011;15(1):114-116. doi:10.4293/108680811X13022985131615