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Cholelithiasis is a common gastrointestinal pathology with a prevalence of over 6% in the USA. Symptomatic patients can develop cholangitis, biliary colic, pancreatitis and cholecystitis. Surgical management involves laparoscopic or open cholecystectomy. Stones within the common bile duct can be treated with endoscopic retrograde cholangiopancreatography (ERCP). Well-known ERCP complications include pancreatitis, perforation, bleeding and cholangitis. Hepatic hematomas as a complication of ERCP are extremely rare, with fewer than 50 reported cases in the literature. Approximately 22% have required operative management. We present an extremely rare case of ERCP-associated subcapsular hepatic hematoma in a 43-year-old lady that was initially non-operatively managed. She did not improve with antibiotics alone and underwent attempted interventional radiology drainage. Despite this, due to on-going sepsis, the patient underwent laparoscopic necrosectomy and drain placement with continued post-operative irrigation. After a long course of antibiotics and drain irrigation, the patient was discharged with repeated computed tomography imaging showing almost total resolution of the infected collection. This case highlights the extreme rarity of surgical management for post-ERCP subcapsular hepatic hematoma and its successful outcome. J Med Cases. 2021;12(5):186-189 doi: https://doi.org/10.14740/jmc3672

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.

Cardiopulmonary resuscitation (CPR) is an important life-saving procedure in emergency care. However, CPR is associated with various complications. A 41-year-old man was admitted to the intensive care unit after CPR. A sudden decrease in the blood pressure and hematocrit level was recorded. An abdominal computed tomography (CT) showed a large subcapsular hematoma in the left lobe of the liver. With conservative treatment, the hematoma reduced in size, but it was later managed with percutaneous drainage. The patient recovered and was discharged. We obtained a favorable outcome with conservative, nonsurgical treatment. Subcapsular hepatic hematoma is a potential life-threatening complication that should be considered in CPR survivors.

This report presents a case of necrotizing pancreatitis resulting in a large hepatic subcapsular hematoma that led to development of hepatic ischemia and early stages of liver failure. Following surgical decompression, liver function dramatically improved, but large areas of peripheral hepatic infarction had developed. This case demonstrates the risks of a rapidly expanding hepatic subcapsular hematoma, emphasizes the importance of recognizing and aggressively treating active bleeding, and cautions against administering anticoagulation and tissue-plasminogen activator in this clinical scenario. Keywords: Hepatic hematoma, Hepatic infarct, Necrotizing pancreatitis

Introduction: Hepatic hematoma is a rare but possible complication of ERCP. We describe the case of a 75-year old man with a large, 8 × 12 cm, sub-capsular and intra-parenchymal hematoma post ERCP, affecting the right liver segments and treated conservatively. Areas covered: A review of literature has been performed, highlighting two possible mechanisms: hematoma may occur as the result of accidental laceration of a small intrahepatic vessel by the guidewire, whereas the other hypothesis posits that the hepatic damage is secondary to traction on the biliary system exerted by the balloon. We speculate that in case of anomalies of the biliary tree, the incidence of this complication is higher than expected. Expert commentary: In case of hepatic hematoma post ERCP, a conservative approach should always be considered before proceeding to interventional radiologic procedures or to surgical therapy.

One of the pathologies that most frequently cause serious complications, including maternal and perinatal death, is preeclampsia. Among its complications are the development of hemolysis, elevated liver enzymes, and thrombocytopenia (HELLP syndrome), which includes a triad formed by a hepatorenal scenario and the development of thrombocytopenia.

We report the case of a 34-year-old woman with a 32-week pregnancy complicated by recurrent severe preeclampsia, HELLP Class I syndrome, and an intact hepatic hematoma of the right lobe detected by ultrasound. During the cesarean section, the rupture of the hematoma occurred and a gastroesophageal probe of the Sengstaken-Blakemore type was placed to occlude the bleeding cavity and the exit tunnel. The balloons were deflated gradually and the probe was removed on the 10th day without complications. The Sengstaken-Blakemore probe can be an effective remedy to control liver bleeding in selected cases.

We present the unique case of a young female woman with an infected left liver hematoma as a complication of a previous endoscopic retrograde cholangiopancreatography for a choledocolithiasis. Urgent liver resections are rarely indicated and are usually performed in cases of important liver trauma. To our knowledge this is the first case of an urgent liver resection for the rare indication of late hepatic infected hematoma after an ERCP.

Introduction and Background: Urinary diversion with the endoscopic Double-J stent is a frequent procedure; complications can include irritation, suprapubic or flank pain, vesicoureteral reflux, hematuria, or urinary infection. We report a case of hepatic subcapsular hematoma secondary to Double-J stent placement. Case Presentation: A 28-year-old woman presented with a history of Sjögren's disease, nephrocalcinosis, and chronic kidney disease (CKD). The patient underwent multiple percutaneous and endoscopic procedures during the previous 2 years: right kidney: extracorporeal shock wave lithotripsy (SWL) × 4, ureteroscopic lithotripsy × 2, percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery; left kidney: SWL × 2, ureteroscopic lithotripsy × 5, and PCNL. Ultrasound imaging showed severe dilation in the right kidney and moderate dilation in the left kidney. CT scanning without contrast revealed a right pyelourethral dilation caused by a 13 mm ureteral lithiasis; also, cortical atrophy was observed. Urosepsis with exacerbated CKD was diagnosed and bilateral 7F Double-J stents were placed on both sides under general anesthesia. On postoperative day (POD) 8, the patient presented with pain in the right hemithorax and dullness to percussion. CT scans showed a heterogeneous hepatic subcapsular collection, of 15 × 7 × 23 cm, of hematic aspect, displacing vascular structures, and no active bleeding. Treatment was expectant and symptomatic. On POD 16, a new CT scan ruled out progression of the hematoma. The patient was finally discharged on POD 19. Four months later, bilateral semirigid ureteroscopy showed a right ureteral lithiasis of 8 × 7 mm, which was fragmented with a holmium laser. Nineteen months after the first episode, the patient is asymptomatic, with no residual lithiasis or hepatic hematoma. Conclusion: This case shows a very rare complication of Double-J stent placement that could be managed by conservative treatment.

Objetivo. Determinar las características clínicas y manejo de casos de hematoma hepático subcapsular (HHS), como consecuencia de preeclampsia y síndrome HELLP durante los años 2004 al 2016. Diseño. Estudio descriptivo, retrospectivo, tipo serie de casos. Lugar. Instituto Nacional Materno Perinatal, Lima, Perú. Material. Historias clínicas de pacientes con HHS. Métodos. Se revisó los casos de HHS atendidos durante los años 2004 al 2016, identificados en forma retrospectiva. Con fines de comparación, se identificó también los casos de la literatura mundial en PubMed. Principales medidas de resultados. Incidencia, características clínicas, manejo y evolución. Resultados. Se encontró 31 casos de HHS, con incidencia de 1 en 6 000 a 9 000 partos. La edad promedio fue 34 años y 81 % multíparas. La forma de diagnóstico más frecuente fue la visión directa durante la cesárea (45%). El síntoma más frecuente fue dolor en abdomen superior (52%), cefalea (36%), estado de conciencia alterado (31 %) Y hematuria (48%). En 90% se practicó empaquetamiento hepático y en 10% observación y monitoreo. En 44% se colocó Bolsa de Bogotá en la primera intervención quirúrgica y en los últimos 2 años se utiliza el sistema VAC para evitar el síndrome comparta mental. El 74% de los casos sobrevivió y 26% falleció. El promedio de estancia hospitalaria fue de 23,2 días. Conclusiones. La incidencia de hematoma hepático subcapsular como consecuencia de preeclampsia y síndrome HELLP fue 1 en 6 000 a 9 000 partos. La hematuria fue un signo relevante y debiera ser motivo de estudio posterior. El 90% de empaquetamiento hepático tuvo diferencias estadísticas con lo reportado en la literatura mundial (p = 0,0025), debido probablemente a la tendencia en procedimientos conservadores. A pesar de solo usar manejo quirúrgico, la cifra de mortalidad fue similar a la reportada en la literatura mundial (26% versus 17%; p = 0,2702). Objective: To determine the clinical characteristics and management of subcapsular hepatic hematoma (SHH) as a result of severe preeclampsia and HELLP syndrome in the period 2004-2016. Design: Descriptive, retrospective study, series of cases type. Setting: Instituto Nacional Materno Perinatal, Lima, Peru. Material: We reviewed the clinical charts of patients with SHH. Methods: The clinical charts of cases with SHH attended at our institution between 2004 and 2016 were reviewed. Search also included PubMed and the results were compared with those in the literature. Main outcome measures: Incidence, clinical features, diagnosis, management and results. Results: 31 cases of SHH were found, with an incidence of 1 in 6 000 to 9 000 births. The mean maternal age was 34 years and 80% were multiparous. Diagnosis was usually through direct visualization of the hepatic rupture during caesarean section (45%). The most frequent symptoms were upper abdominal pain (52%), headache (36%), alteration of consciousness (31 %) and hematuria (48%). Liver packing was performed in 90% of the cases; observation and monitoring, in 10%. In 44% of cases, a Bogotá bag was placed during the first surgery. During the last 2 years, we have recurred to vacuum-assisted closure to prevent compartment syndrome. 74% of cases survived and 26% died. The average hospital stay was 23.2 days. Conclusions: The incidence of subcapsular hepatic hematoma as a result of severe preeclampsia and HELLP syndrome was 1 in 6 000 to 9 000 births. Hematuria was a significant sign and should be studied further. Liver packing was performed in 90% of patients, a statistically significant higher rate than that reported in the literature (p=0.0025), maybe due to a preference for conservative management. Despite only performing surgical treatment, the mortality rate was similar to that reported in the literature (26% versus 17%; p=0.2702).

Hepatic subcapsular hematoma is a rare and lethal complication of HELLP syndrome presenting during pregnancy or the postpartum in women with severe preeclampsia or eclampsia. Maternal and perinatal mortality is high, hence the importance of prevention, early recognition, and timely and multidisciplinary treatment. We present a case of spontaneous rupture of subcapsular hepatic hematoma in which treatment consisted in electrofulguration and placement of hemostatic mesh, and a review of the literature. El hematoma subcapsular hepático es una complicación rara y letal del síndrome HELLP, que se presenta en gestantes o puérperas con preeclampsia severa o eclampsia. La mortalidad materna y perinatal en estos casos es elevada. De ahí la importancia de su prevención, reconocimiento precoz y tratamiento oportuno y multidisciplinario. Se presenta un caso de rotura espontánea de hematoma subcapsular hepático, en el cual se realizó manejo con electrofulguración asociada a la colocación de malla hemostática. Se realiza revisión bibliográfica.

Spontaneous subcapsular hematoma of the liver is an extremely rare but potentially life-threatening condition. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy or trauma. A CT scan of the abdomen demonstrated a huge subcapsular hematoma around the liver. The patient was treated conservatively and was discharged home after one week. Up to our knowledge, this is one of the very few reported cases of a spontaneous subcapsular hepatic hematoma.

Corresponding Author: Dr. Ali SOLMAZ E-mail: solmazali@hotmail.com Received: December 7, 2015 | Accepted: December 24, 2015 | Published Online: January 30, 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Conflict of interest: None declared | Source of funding: Nil | DOI: http://dx.doi.org/10.17659/01.2016.0011

Subcapsular liver hematoma is rare complication of severe preeclampsia and HELLP syndrome, thus making it essential for these patients to be followed up in critical and intensive care units for advanced medical support with fluid and electrolyte management and replacement of blood products while treating underlying disorders. Treatment options have to be individualised and vary from conservative management to surgical treatment including hepatic resection, hepatic artery ligation, and liver transplantation. In this paper we report a case of ruptured hepatic hematoma in a 35 year old female, few hours within delivery, a complication of severe preeclampsia and HELLP syndrome

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technique with high success rate for diagnosis and treatment of biliary and pancreatic diseases, but haemorrhagic complications usually occurs when utilizing Endoscopic Sphincterotomy (EST) or Endoscopic Papillotomy (EPT). Here, we described the case of a 37-y-old female whose Common Bile Duct (CBD) stones were removed via ERCP and EPT due to dilated gallbladder and CBD obstruction. However, the patient suffered from subcapsular hepatic hematoma, sepsis, acute pancreatitis after ERCP. We arranged a second ERCP, Endoscopic Naso-Biliary Drainage (ENBD) and removed stones from gallbladder and junction of CBD and Common Hepatic Duct (CHD) by the Laparoscopic Common Bile Duct Exploration (LCBDE), as well as long-term antibiotic treatment. The patient then had a good condition of postoperative recovery. Hence, it should be alarming that subcapsular hepatic hematoma could be a potential complication post- ERCP and is life-threatening, and we provided the experience of utilizing a number of diagnostic techniques and a multidisciplinary approach of therapy strategies for resolving such complication successfully.

CERVOXY ACL CLIN; International audience; HELLP syndrome, which consists of hemolysis, elevated liver enzymes, and low platelet count is an unusual complication of pregnancy that is observed in only 10% to 15% of women with preeclampsia. Hepatic involvement in HELLP syndrome may present with various imaging features depending on the specific condition that includes nonspecific abnormalities such as perihepatic free fluid, hepatic steatosis, liver enlargement, and periportal halo that may precede more severe conditions such as hepatic hematoma and hepatic rupture with hemoperitoneum. Maternal clinical symptoms may be nonspecific and easily mistaken for a variety of other conditions that should be recognized. Because hepatic hematoma occurring in association with preeclampsia and HELLP syndrome is a potentially life-threatening complication, prompt depiction is critical and may help reduce morbidity and mortality. This review provides an update on demographics, risk factors, pathophysiology, and clinical features of hepatic complications due to HELLP syndrome along with a special emphasis on the imaging features of these uncommon conditions.

L'hématome hépatique est une affection méconnue, peut être gravissime et son diagnostic se fait souvent lors de l'autopsie périnatale. Devant une symptomatologie clinique, souvent, non spécifique et un tableau biologique retardé, le diagnostic est basé essentiellement sur l'échographie et le traitement est souvent conservateur. Nous rapportons un cas d'hématome hépatique chez un nouveau-né à terme, asymptomatique dans un contexte de traumatisme obstétrical.Mots clés: Hématome, foie, nouveau-né, traumatisme obstétricalEnglish Title: Hepatic hematoma in neonates: about a caseEnglish AbstractHepatic hematoma is a condition of unrecognized origin which can become extremely serious and whose diagnosis is often made during perinatal autopsy. It is often characterised by nonspecific clinical manifestations and a long delay before biological presentation.The diagnosis is essentially based on ultrasound and treatment is often conservative.We here report a case of a full-term newborn with asymptomatic hepatic haematoma due to obstetrical trauma.Keywords: Hematoma, liver, new-born, obstetrical trauma

Nowadays endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive technique with a complication rate around 2.5% in expert hands, being the most frequent: acute pancreatitis, cholangitis, hemorrhage and perforation. An exceptional complication is subcapsular hepatic hematoma, first published in the literature in 2000, with few cases reported. Regarding the case published by Del Moral Martínez et al (Hepatic Hematoma after ERCP: presentation of two new cases. Rev Esp Enferm Dig 2017, Vol. 109, No. 6, pp. 470-473) we would like to contribute a reflection based on a recent clinical case in our center.

ERCP is an endoscopic procedure with a complication risk ranging from 2.5 to 8%. The most frequent complications are pancreatitis, cholangitis, hemorrhage or perforation. Hepatic hematoma after ERCP is a potentially serious, rare complication. Not many cases are reported in the literature. We present here two new cases of hepatic hematoma following ERCP along with a review of the literature and possible therapeutic options.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Clinically significant hemorrhagic complications associated usually to previous papillotomy are uncommon. Subcapsular hepatic hematoma is excepcional, with only twenty cases described. We present a case of a 52-year-old man who developed a large subcapsular liver hematoma following a therapeutic ERCP. Due to serious anemization and hemodynamic instability, arterial embolization and finally urgent surgical evacuation of the hematoma were performed. In the postoperative period the patient presented infection of the collection, which indicated colocation of percutaneous drainage and broad-spectrum intravenous antibiotics, and gradually recovered.

In Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

La rotura hepática espontánea es una complicación rara y de alta mortalidad, asociado al síndrome Hellp y preeclampsia severa. La incidencia de rotura hepática varía de 1 en 45 000 a 1 en 225 000 de todos los embarazos. Se relata la experiencia institucional de manejo y tratamiento de la rotura hepática asociada a preeclampsia severa y síndrome Hellp, en una mujer de 29 años, con gestación de 39 semanas, que acudió a la emergencia por dinámica uterina. Luego de 3 horas presentó epigastralgia, dolor en brazo derecho y plaquetopenia, por lo que se decidió culminar el embarazo por cesárea, con recién nacido Ápgar 8 y 9; se evidenció hemoperitoneo y solución de continuidad de la cápsula de Glisson y hematoma hepático. Se realizó taponamiento hepático. Al cuarto día se reintervino para el retiro de gasas, con éxito y evolución favorable.

Introduction: Afibrinogenemia is a rare coagulation disorder. Clinical features of spontaneous bleeding, bleeding after minor trauma, or after surgery have been described as well as thrombo-embolic complications. In this article, we presented the case of a 19-year old female with congenital afibrinogenemia who was admitted with a spontaneous intrahepatic hematoma. Conclusions: Supportive treatment including transfusion and fibrinogen administration, associated with repeated packing surgeries and selective embolization, were successfully performed.

This report describes the case of a patient who developed a subcapsular hepatic hematoma 48 hours after endoscopic retrograde cholangiopancreatography. She was treated by embolizing the sites of bleeding and by surgically resecting the area. We review the literature and discuss the potential mechanisms that cause this complication.

Lysozyme (ALys) amyloidosis (Online Mendelian Inheritance in Man 153450), first identified in 1993 by Pepys et al., is a very rare autosomal dominant hereditary non-neuropathic amyloidosis [1]. Lys...

The endoscopic retrograde cholangiopancreatography (ERCP) is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.

Single incision laparoscopic cholecystectomy may pose significant risks that warrant operative caution. The authors suggest that single incision laparoscopic surgery be compared to the “gold-standard” laparoscopic procedure to further elucidate benefits and complications of this novel technique., Background and Objectives: Many laparoscopic surgeons are now transitioning from standard multiple-port laparoscopic cholecystectomy to single-incision laparoscopic surgery (SILS) in an attempt to improve cosmetic outcomes and decrease postoperative morbidity. However, little has been published regarding the potential complications of SILS operations. Methods: We report the case of a patient undergoing SILS cholecystectomy who developed the complication of a large hepatic hematoma, resulting in significant postoperative morbidity, blood transfusion requirement, and reoperation. Results: After an in-depth internal review of the postoperative morbidity of this case, it appears that the causative factor may be instrument shaft torque on the liver surface. Conclusion: Single-incision laparoscopic surgery may pose significant and unique risks that warrant additional operative caution. Quantitative comparison of SILS to the gold-standard laparoscopic cholecystectomy is needed to further elucidate definitive benefits and complications of this novel technique.

Umbilical vessel catheterization is common practice for infants in the neonatal intensive care unit (NICU). Umbilical venous catheters (UVC) although very useful as a means of obtaining vascular access, do not come without risks. Here we will describe three separate cases of infants in the NICU who, during their course of treatment, were found to have hepatic masses attributed to UVC misplacement. Two of the cases presented incidentally and one presented acutely. We believe liver hematomas may be a more common complication of malpositioned UVCs than previously believed. An appreciation of the complications of malpositioned UVCs should alert clinicians to screen for potential complications and to ensure ideal line placement.

A 33-year-old man with hepatic bleeding was transferred to our hospital. Conventional plain and enhanced spiral computed tomography (CT) with a Siemens Somatom Plus-S scanner (Siemens AG, Erlangen, Germany) revealed a large hepatic hematoma and active extrahepatic bleeding. A unified spiral CT and angiography system (IVR-CT/Angio system; Toshiba Medical Systems, Tokyo, Japan) was employed, and selective catheterization-aided CT arteriography (CTA) showed additional active extrahepatic bleeding. These findings were not detected on conventional spiral CT or angiography. The CTA findings led us to successful transarterial embolization (TAE). After TAE, CT scan revealed that the contrast material injected in the hepatic artery was diffusing into the periportal space. Twenty-four days after TAE, a central bisegmentectomy of the liver was performed. Unfortunately, the cause of the hepatic bleeding was not clear pathologically.

Subcapsular hepatic hematoma is an infrequent and severe complication of hypertension in pregnancy and should be suspected when there are clinical signs compatible with this diagnosis, which should be confirmed by abdominal computed tomography. Prompt diagnosis and treatment are important to avoid rupture, thus improving the high associated maternal and fetal morbidity and mortality.

Hepatic hematomas in neonates are uncommon lesions. When they are large or subcapsular in location, they can rupture with clinical signs of hemoperitoneum. We report a case of subcapsular hepatic hematoma (SHH) associated with a high level of alpha-fetoprotein (AFP), for which diagnosis was made with conservative management, following up with the reduction in size at ultrasound examination and the reduction of the level of AFP.

We present a case of subcapsular hepatic hematoma resulting from retraction of the liver during laparoscopic adrenalectomy. We discuss the management and prevention of this rare and important complication.

Subcapsular and intraparenchymatous hepatic hematomas (HH) raise special management problems due to parenchymatous associated lesions. Despite intense and rapid liver regeneration, this process is affected by the presence of the bile. Therefore the nonoperative management determines a weak and slow healing. The drainage of the fluid (biliohepatic collection), by surgical hepatostomy or percutaneous drainage, promotes optimal cure. Laparotomy with surgical solutioning of the HH is a method associated with important morbidity and mortality, but percutaneous transhepatic US guided drainage represents a minimal invasive alternative for selected cases. We performed percutaneous US guided drainage in three patients with symptomatic posttraumatic HH, six weeks after the accident. The liquid collections were initially sanguine, then biliary. The punction was followed by the placing of a multiperforated tube with enclosed drainage for a maximum period of 21 days. The evolution proved to be rapidly favorable with complete healing, clinical, imagistic (ultrasonography, computed tomography) and biological, 3 months after the procedure. The study confirms the efficient minimal invasive approach for selected cases of posttraumatic subcapsular HH.

Varon de 70 anos, en estudio por masa hepatica izquierda de 7 7 cm (fig. 1) con implantes peritoneales, que tras biopsia percutanea presento epigastralgia intensa asociada a crisis hipertensiva. Se realizo TC observando un gran hematoma intrahepatico con sangrado activo, que ocupaba la practica totalidad del higado, con una morfologia anomala simulando lesiones metastasicas (figs. 2 y 3). La arteriografia mostro una hemorragia activa en segmento IV (fig. 4) controlandose con embolizacion arterial. Tras la embolizacion presento citolisis intensa (GPT 4.400 UI/l) que mejoro paulatinamente, siendo dado de alta tras TC de control a los 13 dias del ingreso. c i r e s p . 2 0 1 5 ; 9 3 ( 6 ) : 4 1 1

Hepatic perforation is an unusual complication of woman pregnancy associated with a poor outcome. A comprehensive review of epidemiology, clinical spectrum, diagnostic methods and therapeutic options is presented in this short paper.