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

• Published in: BMC surgery 2019-01, Vol.19 (1), p.3-3, Article 3
• Main Authors: Liu, Qiao-Fei, Bian, Ling-Ling, Sun, Meng-Qing, Zhang, Rong-Hua, Wang, Wei-Bin, Li, Yong-Ning, Guo, Jun-Chao
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Bile; Bleeding; Blood; Case Report; Case reports; CAT scans; Cholecystectomy; Cholecystectomy, Laparoscopic - adverse effects; Cholecystitis; Cholecystitis, Acute - surgery; Complication; Complications; Complications and side effects; Computed tomography; Diagnostic imaging; Drainage - methods; Emergency medical services; Exploration; Female; Gallbladder; Gallbladder diseases; Glycosylated hemoglobin; Hematoma; Hematoma - etiology; Hemodynamics; Hemoglobin; Hemoglobins; Hemorrhage; Hemorrhagic shock; Humans; Intrahepatic subcapsular hematoma; Laparoscopic cholecystectomy; Laparoscopy; Literature reviews; Liver; Liver Diseases - diagnosis; Medical imaging; Pain; Patients; Resuscitation; Shock; Surgery; Tomography; Tomography, X-Ray Computed
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-018-0453-9

Intrahepatic 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. A 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. Giant 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.