SUBCAPSULAR LIVER HEMATOMA – A COMPLICATION AFTER LAPAROSCOPIC CHOLECISTECTOMY

Subcapsular liver haematoma is among the most severe complications after laparoscopic cholecistectomy, but occurs rarely. The hematoma is usually located around the right lobe of the liver (in 75% of patients). We report the case of a 71 year old patient who underwent laparoscopic cholecistectomy for acute colecistitis. Initial postoperative evolution was favorable. On postoperative day 3 patient presents intense abdominal pain and decreased hemoglobin. The CT shows subcapsular hepatic hematoma. Emergency surgery is performed for signs of hemorragic shock with evacuation of the hematoma and hemostasis. Postoperative evolution is good. There are several theories proposed for the occurance of a subcapsular hematoma of the liver after laparoscopic cholecistectomy. Among these, the presence of a hemangioma, the use of NSAIDs or low molecular weight heparin. No clear mecanism is known and the only clinical sign can be abdominal pain. This case reminds us that we must take abdominal pain seriously after cholecystectomy in order to identify severe complications that can occur, such as hepatic subcapsular hematoma.