Large spontaneous subcapsular hematoma of the liver: a rare case report

Spontaneous idiopathic liver hemorrhage: a systematic review of a rare entity

BACKGROUND

Spontaneous idiopathic liver hemorrhage (SILH) is a rare life-threatening condition occurring without a clear and specific etiology. A systematic review was performed to provide guidelines for the perioperative management of patients affected by SILH. A case report was also included.

METHODS

A systematic search of the last 24-year literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines.

RESULTS

After an initial selection of 6995 titles, 15 articles were considered for the final qualitative analysis (n = 22 patients, including the present report). Conservative treatment was chosen in 12 cases (54.5%) with stable clinical conditions, while 9 patients (40.9%) required a primary operative approach for emergency presentation at diagnosis. Direct liver resection was the preferred surgical treatment (n = 6), mostly major hepatectomies (n = 4). Hepatic arterial embolization was performed as the primary operative approach in three patients, followed by emergency laparotomy during the same hospitalization because of rebleeding in one case. Contrast-enhanced CT scan was the gold standard for diagnosis (n = 19).

CONCLUSIONS

Conservative treatment of SILH is mainly based on stable clinical conditions and may be considered even in case of a limited arterial blush found on imaging. The absence of underlying hepatic or systemic disorders seems to correlate with favorable outcomes and no mortality.

Massive spontaneous nontraumatic subcapsular hepatic hematoma treated using arterial embolization: A case report and review of the literature

A nontraumatic and idiopathic spontaneous subcapsular hepatic hematoma is a rare but often fatal condition. Herein, we report a case of nontraumatic progressive massive subcapsular hepatic hematoma that straddled both liver lobes and was successfully treated by repeated arterial embolization. Following treatment, the hematoma did not progress.

An infrequently encountered case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm

Hepatic artery pseudoaneurysm (HAP) is a rare complication of liver trauma and liver transplant, and spontaneous subcapsular liver hematoma is not frequently encountered outside the setting of preeclampsia and hemolysis, elevated liver enzyme and low platelet (HELLP) syndrome. We report a rare case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm without any apparent liver trauma or recent interventional procedures of the hepatobiliary system. Although subcapsular hepatic hematoma and HAP are uncommon diagnoses, clinicians should be aware of these diagnoses to promptly diagnose and effectively treat them. Clinicians should also not forget these diseases could be masked by other common etiologies, such as gastritis.

A Lethal Pursuit of Beauty: Tight-Lacing, the Faja Corset, and a Subcapsular Hematoma

Faja corset, a tight garment worn to obtain an hourglass body, may have contributed to the formation of a spontaneous subcapsular hematoma in a 38-year-old nulligravid woman with no history of trauma. Subcapsular hematomas of the liver are a rare occurrence, with many documented cases arising during pregnancy as a complication of HELLP (hemolysis, elevated liver enzymes, and low platelet) syndrome. Additional causes include iatrogenic trauma, rupture of cysts, hepatic adenomas, hepatocellular carcinoma, or coagulopathies. Idiopathic or spontaneous cases are very rare. In this report, we discuss the case of a 38-year-old female who presented with a spontaneous subcapsular liver hematoma of unclear etiology, most likely related to compression by her faja corset.