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Subcapsular Liver Hematoma

Hepatic Subcapsular Hematoma


Presentation

  • Mycotic aneurysm or pseudoaneurysm of visceral vessels may develop from bacteremia and its dissection or rupture should be suspected in patients presenting with sepsis and abdominal pain.[ncbi.nlm.nih.gov]
  • In physical examination epigastric tenderness was present. Patient went under ERCP procedure due to choledocholithiasis. 1.5 cm of filling defect was seen in hilar region in ERCP.[scopemed.org]
Fever
  • General Discussion: FULL PATIENT HISTORY: 22-year-old woman with fever, shortness of breath, abdominal pain and abnormal liver function tests 2 weeks after laparoscopic cholecystectomy.[gamma.wustl.edu]
  • Patient was admitted presenting fever and abdominal pain postoperative month 1. USG and CT revealed that an approximately 10x3 cm heterogenic collection adjacent to the left lobe of the liver was reaching out to epigastrium.[scopemed.org]
  • Discussion We describe a case of diagnosed subcapsular liver hematoma (SLH) detected in a full- term neonate born after an uncomplicated pregnancy and delivery, without a history of fever or coagulopathy.[omicsonline.org]
  • Different symptoms are described in literature abdominal pain (91%), hypotension (39.1%), anemia (39.1%), fever (21.7%) and peritonism (13%) [8].[ijhpd.com]
  • The most common manifestation was abdominal pain in 87%; in some case reports fever was mentioned to be one of the primary manifestations, but we found that right omalgia and clinical manifestations of hypovolemic shock (tachycardia or hypotension) were[elsevier.es]
Nightmare
  • Rupture of Subcapsular Hematoma of Liver in Severe Preeclampsia with HELLP syndrome: A Nightmare to an Obstetrician Corresponding Author: Dr.[casereports.in]
Abdominal Pain
  • Mycotic aneurysm or pseudoaneurysm of visceral vessels may develop from bacteremia and its dissection or rupture should be suspected in patients presenting with sepsis and abdominal pain.[ncbi.nlm.nih.gov]
  • A sixty-nine-year-old female patient was admitted to the clinic with abdominal pain and jaundice. In physical examination epigastric tenderness was present.[scopemed.org]
  • 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.[ci.nii.ac.jp]
  • Different symptoms are described in literature abdominal pain (91%), hypotension (39.1%), anemia (39.1%), fever (21.7%) and peritonism (13%) [8].[ijhpd.com]
Hematemesis
  • She developed tachycardia (pulse rate 115 beats per minute and blood pressure 100/60 mmHg) with a drop of hemoglobin of 2 g/dl without melena or hematemesis.[ijhpd.com]
  • When applying clinical criteria such as melena, hematemesis, a drop greater than 2 g/dL in hemoglobin level, or requirement for secondary intervention such as endoscopy or blood transfusion, the overall incidence of bleeding is around 0.1–2% even in experienced[elsevier.es]
Abdominal Mass
  • Subcapsular hematomas of the liver in neonates uncommonly present as an abdominal mass without clinical signs of bleeding.[ncbi.nlm.nih.gov]
Recurrent Abdominal Pain
  • Case report A 25-year-old female with a history of pregnancy and C section 7 months prior to admission presented with recurrent abdominal pain in the upper right quadrant 15 days prior admission, the pain was accompanied by nausea, vomititing, and jaundice[elsevier.es]
Lower Abdominal Pain
  • An unbooked, 25-year-old primigravida, at 21 weeks' gestation, self-referred herself and presented to the Obstetric Emergency Unit, with a one-day history of spontaneous, severe, lower abdominal pain of gradual onset that was associated with dizziness[njcponline.com]
Hepatomegaly
  • Congenital malformation of liver NOS nodular, focal K76.89 Hypertrophy, hypertrophic liver R16.0 ICD-10-CM Diagnosis Code R16.0 Hepatomegaly, not elsewhere classified 2016 2017 2018 2019 Billable/Specific Code Applicable To Hepatomegaly NOS acute K76.89[icd10data.com]
  • There are three major causes of hepatic injury in neonates: • obstetrical causes such as difficult labor, early travail and a breech presentation; • neonatal causes such as hepatomegaly, coagulopathy, resuscitation, prematurity or post-maturity; • maternal[omicsonline.org]
  • ALP isoenzyme test (Medical Encyclopedia) Ascites (Medical Encyclopedia) Diet - liver disease (Medical Encyclopedia) Hepatic encephalopathy (Medical Encyclopedia) Hepatomegaly (Medical Encyclopedia) Liver disease (Medical Encyclopedia) Liver scan (Medical[icdlist.com]
  • On examination, she was found to have mild pallor, and a tender hepatomegaly. There was no icterus and the patient was hemodynamically stable, her blood pressure was also normal.[panafrican-med-journal.com]
  • On physical examination, the patient had hepatomegaly and was tender to right upper quadrant palpation. The physical exam was otherwise within normal limits.[uscapknowledgehub.org]
Hepatic Mass
Visual Impairment
  • The patient’s complaints were frontal headache and visual impairment. Her arterial blood pressure was 160/100 mmHg.[casereports.in]
Excitement
  • A physical examination showed severe pallor, blood pressure of 95/62 mmHg, a distended and peritonitic abdomen, an abdominopelvic mass of 20 weeks with a smooth contour, and a closed cervical os, with cervical excitation tenderness.[njcponline.com]
Dizziness
  • An unbooked, 25-year-old primigravida, at 21 weeks' gestation, self-referred herself and presented to the Obstetric Emergency Unit, with a one-day history of spontaneous, severe, lower abdominal pain of gradual onset that was associated with dizziness[njcponline.com]
Cesarean Section
  • We describe successful conservative management of ruptured subcapsular liver hematoma in a woman with preeclampsia who had hemoperitoneum seen at cesarean section.[ncbi.nlm.nih.gov]
  • Hepatic rupture after cesarean section in a patient with HELLP syndrome: a case report and review of the literature. Archives of Gynecology and Obstetrics. 2007;276(2):189-192. R obb ins S, Cotran RS, Kumar V.[casereports.in]
  • Past medical history was significant for 2 cesarean sections, post partum depression, and oral contraceptive use. She did not smoke or drink alcohol. Her last menstrual period was 2 weeks prior to referral.[uscapknowledgehub.org]
  • A cesarean section was performed 68 hours after admission. In the recovery room, the patient was noted to be hypotensive, tachycardic and anuric. Repeat labs (Table 1) revealed new onset thrombocytopenia and worsening liver function.[ispub.com]
Vaginal Bleeding
  • The third patient experienced uncontrollable vaginal bleeding, liver hemorrhage, and was in imminent danger of capsule rupture.[ncbi.nlm.nih.gov]
Vaginal Discharge
  • There were no urinary symptoms, changes in bowel habits, trauma, vaginal discharge or bleeding, and no other contributory history was identified.[njcponline.com]

Workup

  • The final genetic workup was available only after discharge and detected a complement factor H haplotype H3 ( 332T, c.184G, c.1204T, c.2016G, and c.2808T).[revistanefrologia.com]
Pericardial Effusion
  • Sudden onset breathlessness on day 6 secondary to pleural and pericardial effusion was managed conservatively [Fig.3]. Over the time, drain output reduced and drain was removed by 20 and 25 day respectively.[casereports.in]
Fasciola Hepatica
  • Evaluation of Fas2-ELISA for the serological detection of Fasciola hepatica infection in humans, Am J Trop Med Hyg, 2007, vol. 76 (pg. 977 - 82 ) 11.[academic.oup.com]
Pseudomonas
  • The patient subsequently developed intra-abdominal sepsis resulting in two additional re-laparotomies to wash out the serosanguinous fluid from where Pseudomonas, sensitive to ceftazidine, was isolated.[njcponline.com]

Treatment

  • Recombinant factor VIIa is an effective adjunct in the treatment of preeclamptic patients with expanding or ruptured subcapsular liver hematoma.[ncbi.nlm.nih.gov]
  • Comprehensive discussions of clinical disorders review the surgical treatment options.[books.google.com]

Prognosis

  • , Queen Elizabeth Hospital, Bridgetown, Barbados. lokakinthala@yahoo.com Abstract HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is an obstetric complication with heterogeneous presentation, multisystem involvement and variable prognosis[ncbi.nlm.nih.gov]
  • Ortiz,Seila García Mulas,Juan Carlos Ávila Alegría,Javier García Lledó,Leticia Pérez Carazo,Beatriz Merino Rodríguez,Manuel González Leyte,Óscar Nogales Gastroenterología y Hepatología. 2018; 3 Systematic review: Features, diagnosis, management and prognosis[jdeonline.in]
  • […] unenhanced aberrant portal or hepatic veins congenital fissures and clefts: typically fat density, and in usualy locations diaphragmatic slips or eventration : identifiable on coronal images pre-existing liver lesions cysts hemangioma Treatment and prognosis[radiopaedia.org]
  • Multicenter prospective clinical study to evaluate the prediction of short-term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol. BMC Pregnancy Childbirth. 2014 Sep 18; 14: 324 22.[cobas.roche.it]

Etiology

  • We describe the pertinent radiologic features of the subcapsular hematomas in these patients, and discuss possible etiologies for the bleeding in each patient.[uthsc.pure.elsevier.com]
  • Routine pathological examination of the explanted liver failed to reveal the etiology of the rupture.[scinapse.io]
  • Spontaneous hepatic rupture with intraperitoneal hemorrhage without underlying etiology: a report of two cases. ISRN Surg, 2011 (2011), pp. 610747 [10] D. Cernea, A. Dragoescu, M. Novac.[revistanefrologia.com]
  • In summary, we present a case of a newborn with an SHL, which was idiopathic in etiology.[omicsonline.org]
  • The etiology of the hematoma is not entirely clear. Most of the authors claimed that it is caused by rupture of small caliber vessels due to the guidewire trauma [5] [6] [7].[ijhpd.com]

Epidemiology

  • Roberts, MD is Professor of Obstetrics and Gynecology and Epidemiology and Clinical and Translational Research at the University of Pittsburgh.[books.google.com]
  • Epidemiology of endometriosis-associated infertility. J Reproductive Med 1982;34:41.[uscapknowledgehub.org]
Sex distribution
Age distribution

Pathophysiology

  • A review of the known and proposed risk factors, clinical signs and symptoms, pathophysiology, and treatment of both SBP and SLH are provided.[ncbi.nlm.nih.gov]
  • Gastrointestinal Surgery: Pathophysiology and Management is an invaluable reference text for surgeons and surgical trainees. Written entirely by Dr. Haile T.[books.google.com]
  • The pathophysiologic mechanism underlying the development of the hematoma is not clearly defined, however various authors agree that vascular injury of small-caliber intrahepatic vessels secondary to guidewire use may be the cause, which may also explain[elsevier.es]

Prevention

  • Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. ‎ Página 84 - Tanner JM, Whitehouse RH, Marubini E, Resele LF. The adolescent growth spurt of boys and girls of the Harpenden growth study. ‎[books.google.es]
  • PEX was suspended to prevent increased hepatic bleeding related with heparin systemic anticoagulation. Ultrasonography follow-up examinations revealed almost unchanged size of hematoma.[revistanefrologia.com]
  • As the guidewire may be sources of infection we recommend prophylactic broad spectrum antibiotics for these patients to prevent hematoma infection and abscess formation.[ijhpd.com]
  • He led an NIH RCT (10,000 women) of antioxidant vitamins to prevent preeclampsia.[books.google.com]
  • X-ray control of the position of the guide-wire may prevent this rare complication of interventional ERCP.[thieme-connect.com]

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