Abstract
Spontaneous subcapsular liver hematoma (SLH) is extremely rare. We report here a case of a 74-year-old male, with a rare complication of anticoagulant therapy. The patient was admitted to the emergency unit with complaints of pain in the right upper quadrant and respiratory distress. He had abnormal coagulation parameters with a prolonged prothrombin time and elevated INR value. Computed tomography (CT) scan showed a giant hematoma, measuring more than 18 cm in diameter, in the right lobe of the liver. Despite a twomonths conservative treatment, abdominal complaints persisted and the liver hematoma eventually progressed in size. The patient underwent laparotomy, the capsule was opened and approximately 2 liters of hematoma was evacuated. His postoperative course was generally downhill. On the 22nd day of follow-up he died due to respiratory insufficiency and sepsis. Conservative management is the mainstay therapy for the non-ruptured SLH unless the patient's general condition worsens due to enlarging hematoma. SLH should be considered in the differential diagnosis in patients presenting with abdominal pain while receiving oral anticoagulants.
Keywords: Liver hematoma, anticoagulant therapy, conservative management
References
Liu CJ, Chien RN, Yen CL, et al. Spontaneous rupture of the liver in a patient with chronic hepatitis B and D. World J Gastroenterol 2007;13:4405-4407.
Scott DA, Netchvolodoff CV, Bacon BR. Delayed subcapsular hematoma after percutaneous liver biopsy as a manifestation of warfarin toxicity. Am J Gastroenterol 1991;86:503-505.
Xavier P, Melo R, Amandio V, et al. Subcapsular hepatic hematoma in an otherwise uncomplicated pregnancy. Arch Gynecol Obstet 2002;266:44-45.
Erichsen C, Sndenaa K, Sreide JA, et al. Spontaneous liver hematomas induced by anti-coagulation therapy. A case report and review of the literature. Hepatogastroenterology 1993;40:402-406.
Polat C, Dervisoglu A, Guven H, et al. Anticoagulant-induced intramural intestinal hematoma. Am J Emerg Med 2003;21:208-211.
Behranwala KA, Tisdall M, Habib NH, et al. Spontaneous bilobar subcapsular hematoma of the liver while undergoing anticoagulation therapy: our experience and review of the literature. Int Surg 2004;89:212-216.
Cozzi PJ, Morris DL. Two cases of spontaneous liver rupture and literature review. HPB Surgery 1996;9:257.
Yu MC, Jeng LB, Lee WC, et al. Giant intrahepatic hematoma after liver biopsy in a liver transplant recipient. Transplant Proc 2000;32:2217–2218.
Gordetsky J, Hislop S, Orloff M, et al. Subcapsular hepatic hematoma with right hepatic vein thrombosis: a complication of shock wave lithotripsy. Can Urol Assoc J 2008;2:61-63.
Dizadji H, Hammer R, Strzyz B, et al. Spontaneous rupture of the liver. A complication of oral anticoagulant therapy. Arch Surg 1979;114:734-735.
