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Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Urolithiasis is a common urological condition that affects around 8 per 1000 people every year. Management depends on multiple factors varying between stone related and patient related factors. In some cases, shock wave lithotripsy (SWL), one of the most popular noninvasive and safe procedures, is required where conservative measures fail. However, it can lead to life-threatening complications. Here we present rare case of hepatic hematoma in a 57-year-old female patient following SWL for right kidney stone on the 2nd day post-SWL. The patient was managed successfully with conservative measures.

Microangiopathic hemolytic anemia, elevated liver enzymes and low platelet count, also known as HELLP syndrome, is a rare complication of pregnancy with high maternal and fetal mortality. One of the most serious complications is a subcapsular liver hematoma. The diagnostic techniques used for diagnosis are ultrasound, CT and MRI. Hemodynamically stable patients should be treated conservatively and in cases of active bleeding with percutaneous embolization of the hepatic arteries. We present a case of a 35-year-old woman with subcapsular liver hematoma with active arterial bleeding who underwent an emergency cesarean section and was treated conservatively with artery embolization with gelatin sponge.

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.

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. [ABSTRACT FROM AUTHOR]

Microangiopathic hemolytic anemia, elevated liver enzymes and low platelet count, also known as HELLP syndrome, is a rare complication of pregnancy with high maternal and fetal mortality. One of the most serious complications is a subcapsular liver hematoma. The diagnostic techniques used for diagnosis are ultrasound, CT and MRI. Hemodynamically stable patients should be treated conservatively and in cases of active bleeding with percutaneous embolization of the hepatic arteries. We present a case of a 35-year-old woman with subcapsular liver hematoma with active arterial bleeding who underwent an emergency cesarean section and was treated conservatively with artery embolization with gelatin sponge. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Hepatic subcapsular hematomas (HSH) are an extremely rare post-endoscopic retrograde cholangiopancreatography (ERCP) complication. Mortality exhibits disparities depending on the integrity of the hepatic capsular envelope, with ruptured HSH being associated with higher case fatality rates (2.2 % compared to 21.4 %). Two clinical cases are presented concerning a 20-year-old female patient and a 40-year-old male patient, who were diagnosed with choledocholithiasis and underwent ERCP procedures with the use of a wide-bore guidewire (WBG), with the undesired result of HSH as a complication. In both scenarios, a surgical approach strategy was chosen to manage this situation. The outcome turned out to be successful in the first case, in contrast to the unfortunate death of the patient in the second case. Conservative approaches prevail in the management of HSH, as they often present intact, resulting in a low mortality rate. However, surgical approaches are reserved for consideration in situations of hemodynamic instability that persists despite the conservative measures implemented. • Hepatic subcapsular hematomas are an extremely rare post-endoscopic retrograde cholangiopancreatography complication • Surgical approaches are reserved for consideration in situations of hemodynamic instability • Mortality exhibits disparities depending on the integrity of the hepatic capsular envelope [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure for indications of pancreatobiliary diseases. Hepatic hematoma is a very rare complication of this procedure. In this case report, we aimed to present subcapsular hepatic hematoma complication and review current literature. A 72-year-old woman was admitted with jaundice to our outpatient clinic. Her lab results were as follows: ALT 700 U/L (15-35), AST: 472 U/L (15-35), ALP: 355 U/L (40-120), T. Bilirubin: 5.5 mg/dl (0.3-1.2), D. Bil: 3.15 mg/dl (0-0.2), GGT: 212 U/L (0-38). Magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced magnetic resonance imaging (MRI) revealed a lesion involving the proximal common bile duct (CBD), possibly extending into both major hepatic bile ducts and causing narrowing of the lumen and contrast enhancement (Klatskin tumor?). Intrahepatic biliary tracts were dilated in both lobes, especially on the left. Due to the involvement of CBD, biliary plastic stenting was performed for malignant biliary obstruction (bismuth type 2) with ERCP. On the second day after ERCP, the patient complained of abdominal pain radiating to the back with no defence and rebound tenderness. Lab results were as follows; ALT: 342 U/L (15-35), AST: 329 U/L (15-35), ALP: 306 U/L (40-120), T. Bilirubin:10.2 mg/dl (0.3-1.2), D. Bil:6, 16 mg/dl (0-0,2), GGT:165 U/L (0-38). Computed tomography showed 45 mm of subcapsular hepatic hematoma with air and liquid on the surface of the right lobe of the liver. The patient was conservatively treated and followed up with antibiotherapy in surgery intensive care unit. She was not suitable for surgery and percutaneous drainage or vascular embolization. In conclusion, subcapsular hepatic hematoma is a rare complication of ERCP. Moreover, its mortality rate is low and it may occur in certain conditions. If abdominal pain, fever, anemia and hypotension develop in the patient, this complication should be considered after ERCP. It should be included in informed consent for the ones who will perform ERCP in endoscopy units. [ABSTRACT FROM AUTHOR]

An analysis of application results of complex research methods of diagnostics of intraorganic hepatic and splenic hematomas was made. At the same time, options of these methods were used for determination of prescription of injury. The ultrasound, CT, MR-imaging, videolaparoscopy, angiography, Doppler ultrasonics, impedometry, biochemical, laboratory and cytological study of punctate sample from hematomas were applied for this purpose in 33 patients. According to authors, an evolution of hematomas happened in 3 stages, each of this stage was characterized by specified data associated with investigation results. The staging procedure of hematomas or their evolution allowed setting the prescription of injury.

Abstract Background Hepatic hematoma (HH) is a rare but severe adverse event following endoscopic retrograde cholangiopancreatography (ERCP). Aims To perform a systematic literature review and describe two additional cases, one of which presenting multiple subcapsular/intrahepatic hematomas after ERCP. Methods The literature review was performed in PubMed/MEDLINE, EMBASE, and SCOPUS to identify all cases reporting on HH after ERCP. Results A total of 48 cases (females 63%, mean age 58.2 ± 20.6 years) were included. The mean symptoms onset time was 46.8 h after ERCP, and the most common symptoms were abdominal pain (91.7%), anaemia (43.8%), hypotension (29.2%) and fever (20.8%). All cases were diagnosed by computed tomography (CT). HH was found mostly in the right hepatic lobe (95.1%) and the mean size was 116 × 93 mm. A conservative management was adopted in 38.3% of cases, while percutaneous drainage, embolization and surgery were needed in 31.9%, 14.9% and 25%. Mortality rate was about 9%. Anaemia (OR 6.9; p = 0.02) and surgery (OR 10.5; p < 0.01) were the only independent factors for unfavorable outcome (death), while abdominal pain (OR 0.1; p = 0.03) and antibiotics administration (OR 0.06; p < 0.001) were associated with better outcome. Conclusions HH is a rare but severe complication following ERCP which needs a multidisciplinary approach. Antibiotics administration is the only treatment able to reduce the risk of death. [ABSTRACT FROM AUTHOR]

ABSTRACTIn 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.

Patients with cardiac pathology that require permanent antithrombotic therapy involve a higher bleeding risk, even in minor traumas, leading to severe consequences. Ultrasound imaging represents a quick and accessible investigation, in order to acquire valuable information, diagnosis and to monitor. The aim is to evaluate the ultrasound aspects in a patient with cardiac pathology, who experienced an apparently minor trauma, but with severe hepatic impact. It is presented the case of an elderly patient, diagnosed with multiple cardiac pathology: arrhythmia (atrial fibrillation, ventricular extrasystoles), hypertension, moderate heart failure, with permanent antithrombotic medication and also other associated pathologic conditions, such as: osteoporosis and spondylosis, who experienced a minor trauma (falling in the same plane), with right thoraco-abdominal impact. Post-traumatic, clinical and imagistic investigations (ultrasound and X-ray) showed costal fractures favored by osteoporosis, as well as contusions and a large hepatic hematoma, which required medical-surgical supervision. During this process, ultrasound investigation played an important role. Emergency ultrasound allowed rapid and complex diagnosis of the lesions in the cardiac patient with minor trauma. Severe lesions were found: a large, hypoecogen intrapanchimal hepatic hematoma, along with other cardiac disturbances (signs of heart failure, suprahepatic veins dilatation, cardiac cavities modifications). Differential diagnosis of the hepatic focal lesion was required [1,2]. Against the background of chronic heart disease and anticoagulants, the presence of large hepatic hematoma required ultrasound monitoring for the assessment of bleeding and hematoma aspect, together with control of medication, regarding anticoagulants and hemostatics [3]. Ultrasound investigation is important in the rapid diagnosis and assessment of post-traumatic injury, such as large hepatic hematoma, in patients with risk factors such as arrhythmic and hypertensive heart disease, antithrombotic chronic therapy, osteoporosis and rib fractures. Complex abdominal, cardiac, thoracic and vascular, non-invasive, risk-free ultrasonography allows the diagnosis of severe lesions, especially hematomas and hemorrhagic acumulations. Post-traumatic injuries, even after minor trauma, require ultrasound investigation, useful in cardiac patients with arrhythmias, hypertension and heart failure, involving the adjustment and control of therapy. [ABSTRACT FROM AUTHOR]

Subcapsular liver hematoma is a rare but potentially life-threatening complication of pree-clampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. It may present with nonspecific signs and symptoms, none of which are diagnostic, and can mimic pulmonary embolism of cholecystitis. There is no consensus on the management of subcapsular liver hematoma. Unruptured liver hematoma can be conservatively managed. When rupture occurs, surgical, endovascular approaches and, rarely, liver transplantation, may be required. Actual literature is scant and retrospective in nature. Data on follow-up, time to resolution and outcome of subsequent pregnancies are very limited. We here review the diagnosis and management of liver hematoma. [ABSTRACT FROM AUTHOR]

La fasciolasis hepática es una zoonosis mundialmente difundida, sobre todo en los países productores de ganado; causada por la fasciola hepática. Se manifiesta por dolor abdominal, fiebre, náuseas y vómitos, baja de peso, diarrea, palidez, malestar general e hipereosinofilia. El diagnóstico es inmunológico y también puede hacerse por recuento de huevos en heces. El hematoma subcapsular e intraparenquimatoso hepático es una complicación rara de la fasciolasis humana pero se debe tener un alto índice de sospecha uniendo epidemiología, clínica, laboratorio e imaginologia para un adecuado diagnóstico y tratamiento. El propósito de reportar estos casos es dar a conocer una patología poco frecuente en la literatura, con una casuística de cuatro pacientes tratados en el lapso de dos años, todos referidos del Departamento de Cajamarca: Hepatic fasciolasis is a worldwide spread zoonoses mainly affecting cattle-raising countries. It is caused by the trematode Fasciola hepática and it is characterized by abdominal pain, fever, nausea and vomitus, weight loss, diahrrea, paleness, general malaise, and hypereosinophilia. Immunological diagnosis as well as stool eggs count may be performed. Hepatic subcapsular and intraparenchymatous hematoma is an infrequent complication of human fascioliasis. Nevertheless, for establishing a proper diagnosis and treatment, any suspicion of its presence must be carefully discarded through, clinical epidemiology, laboratory and imaging exams and procedures. The aim of this study is to expand knowledge on this unfrequently dealt pathology in medical literature by presenting four case reports related to patients undergoing a two-year treatment. All of them had been referred from Departamento de Cajamarca, Peru

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications., (Copyright © 2022 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

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. [ABSTRACT FROM AUTHOR]

Résumé Introduction Le diagnostic d’amylose AL peut être rendu difficile par la diversité et l’absence de spécificité des symptômes engendrés. Observation Nous rapportons un cas d’hématome hépatique atraumatique, conduisant à la découverte d’une amylose hépatique secondaire à un probable myélome multiple. L’élément original est la découverte de deux anomalies de l’hémostase acquises, un déficit en facteur X et un syndrome de Willebrand acquis, par probable inhibiteur. Conclusion Cette observation rappelle l’importance de l’exploration de l’hémostase au cours de l’amylose AL. Introduction Diagnosis of AL amyloidosis can be complicated by the diversity and the absence of specificity of symptoms. Case report We report a patient who presented with a non-traumatic hepatic hematoma, leading to the discovery of hepatic amyloidosis secondary to probable multiple myeloma. The originality of our report lies in the discovery of two acquired abnormalities of haemostasis: a factor X deficiency and an acquired von Willebrand syndrome, by a likely inhibitor. Conclusion Our case report is a reminder of the importance of haemostasis analysis in AL amyloidosis. [ABSTRACT FROM AUTHOR]

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.

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: We present the case of a patient being given anti-hypertensive treatment for 3 months and with a daily 100 mg dosage of acetylsalicylic acid who began showing symptoms 3 weeks prior to the examination with muscular pain, arthralgia and chills, followed by abdominal distension and pain in the right side with irradiation to the left infraescapular region. After the original exam in the emergency room an abdominal ultrasound and tomography showed the presence of hematoma in the left lobe of the liver. Not having shown record of previous trauma, a bleeding time test using the Ivy method was performed with a result of 11 minutes and an altered aggregometry slope. A 24 hour desmopressin infusion was used to correct the bleeding time test. A magnetic resonance corroborated the presence of hepatic hematoma. Drainage by laparoscopic surgery is performed and in 7 days time the patient is released. Discussion: no reports were found about the relationship of hepatic hematoma and the use of platelet drugs. Conclusion: it is possible that the presence of atypical manifestations of bleeding after the consumption of platelet drugs is from multifactor phenomena like: high dosage; pharmacological, nutritional or herbal interactions; non-perceivable trauma; or an elevated response to the effect of the acetylsalicylic acid with different genetic polymorphisms. [ABSTRACT FROM AUTHOR]

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. [ABSTRACT FROM AUTHOR]