A rare intrahepatic subcapsular hematoma (ISH) after laparoscopic cholecystectomy: a case report and literature review

Abstract

BackgroundIntrahepatic subcapsular hematoma (ISH) is an extremely rare, life-threatening complication after laparoscopic cholecystectomy (LC). Only few cases have been reported. Herein, we reported a rare giant ISH after LC and summarized all of the reported cases.Case presentationA 32-year old woman with recurrent acute cholecystitis for one year, underwent elective LC without intra-operative complications and was discharged 2 days after operation. On the next day after discharge, she developed severe right upper abdominal pain and was sent to our emergency department. The computed tomography scan showed a 10.9 × 12.5 × 6.6 cm ISH in the right liver without free fluid and the hemoglobin dropped to 86 g/l from 127 g/l. Postoperative hemorrhagic shock and a giant ISH after LC were diagnosed. After fluid resuscitation, the hemodynamic was still unstable and the hemoglobin kept dropping. An emergency laparoscopic exploration was performed and the ISH was confirmed, however no active bleeding point was found. A drainage tube was placed under liver for early warning of rupture. Patient was discharged home 10 days after readmission.ConclusionsGiant ISH is an extremely rare, life-threatening complication after LC. This case showed that the need to consider this rare complication in patients suffering abdominal pain after LC and timely and correct diagnosis and treatment were crucial to saving the lives of the patients.

Giant Intrahepatic Subcapsular Haematoma: A Rare Complication following Laparoscopic Cholecystectomy—A Case Report and Literature Review

“…These include bleeding, bile duct injury, subhepatic abscess, and choledocholithiasis [ 1 , 2 , 6 ]. Postoperative bleeding is a fairly rare complication following LC occurring in less than 1% [ 5 ]. The most common sites of a possible bleeding following LC include the following: the gallbladder bed, the cystic artery, trocar insertion sites, the falciform ligament, and bleeding from liver capsule tears [ 5 – 8 ].…”

“…Postoperative bleeding is a fairly rare complication following LC occurring in less than 1% [ 5 ]. The most common sites of a possible bleeding following LC include the following: the gallbladder bed, the cystic artery, trocar insertion sites, the falciform ligament, and bleeding from liver capsule tears [ 5 – 8 ]. Occurrence of ISH following LC is a rare event, but it represents a life-threatening complication due to haemodynamic instability, and thus it merits special attention [ 5 , 7 ].…”

“…Specific complications still remain, in particular, bleeding, bile leak, and bile duct injury [ 1 , 2 ]. However, intrahepatic subcapsular haematoma (ISH) represents a rare, but potentially life-threatening complication following LC [ 3 – 5 ]. Few cases have been reported in the literature so far [ 3 – 5 ].…”

“…However, intrahepatic subcapsular haematoma (ISH) represents a rare, but potentially life-threatening complication following LC [ 3 – 5 ]. Few cases have been reported in the literature so far [ 3 – 5 ]. The low incidence of this event would explain in part of the current limited experience for its diagnosis as well as the standard management [ 5 ].…”

“…Few cases have been reported in the literature so far [ 3 – 5 ]. The low incidence of this event would explain in part of the current limited experience for its diagnosis as well as the standard management [ 5 ]. Herein, we report a case of giant ISH following LC which was managed conservatively, and we reviewed all of previously published cases.…”