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Molina GA. et al., 2019: Subcapsular liver hematoma after extracorporeal shock wave lithotripsy, a rare complication

Molina GA, Moyon MA, Moyon FX, Tufiño JF, Guzmán LJ, Mecias RA, Cevallos JM, Serrano DS.
PGY4 Resident General Surgery, P.U.C.E., Quito, Ecuador.
Department of General Surgery Hospital San Francisco, IESS Quito, Ecuador.

Abstract

Extracorporeal shock wave lithotripsy (ESLW) is a common and relatively safe procedure, with a high success rate and low adverse effects. Complications of this procedure are usually limited to the kidneys and almost always resolve spontaneously. However, on rare occasions, a frightening complication, as a hematoma of a parenchymatous organ, such as the liver can appear. Abdominal pain is usually the only manifestation when a liver hematoma develops, and should always be investigated, as this dreaded complication can put the patient's life at risk. Conservative treatment is usually the treatment of choice, nevertheless, on severe cases that do not respond to conservative measures, surgery or embolization is necessary. We report the case of a 38-year-old male who underwent ESWL, 12 h after the procedure he presented to the emergency room with severe abdominal pain, after complementary exams a liver hematoma was detected. Following conservative management, the patient fully recovered.

J Surg Case Rep. 2019 Apr 11;2019(4):rjz114. doi: 10.1093/jscr/rjz114. eCollection 2019 Apr.

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Комментарии 1

Hans-Göran Tiselius в 25.10.2019 08:44

Whenever a patient presents with unexpected pain shortly after SWL, there is reason for great attention and careful examination. Although obstruction caused by passing fragments in the ureter is a possible explanation, parenchyma bleedings always should be on the list of possible diagnoses and excluded by emergency CT-examination.

Subcapsular bleedings - although even those unusual complications - are most common. The liver hematoma described in this report is an extremely rare complication of SWL. The reviewer has not encountered a liver hematoma in more than 20 000 SWL treatments.

The patient in this case report had an Hb-drop of 80 g/L and under these circumstances it can be discussed whether blood replacement should be made or not. This patient obviously was young and healthy and tolerated this blood-loss. Otherwise an Hb-reduction of around 45% is substantial and I should personally have considered blood transfusion.

Important lesson: always be as conservative as possible!

Whenever a patient presents with unexpected pain shortly after SWL, there is reason for great attention and careful examination. Although obstruction caused by passing fragments in the ureter is a possible explanation, parenchyma bleedings always should be on the list of possible diagnoses and excluded by emergency CT-examination. Subcapsular bleedings - although even those unusual complications - are most common. The liver hematoma described in this report is an extremely rare complication of SWL. The reviewer has not encountered a liver hematoma in more than 20 000 SWL treatments. The patient in this case report had an Hb-drop of 80 g/L and under these circumstances it can be discussed whether blood replacement should be made or not. This patient obviously was young and healthy and tolerated this blood-loss. Otherwise an Hb-reduction of around 45% is substantial and I should personally have considered blood transfusion. Important lesson: always be as conservative as possible!
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