Liu Qiao-Fei, Bian Ling-Ling, Sun Meng-Qing, Zhang Rong-Hua, Wang Wei-Bin, Li Yong-Ning, Guo Jun-Chao
Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of International Medical Services, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
BMC Surg. 2019 Jan 7;19(1):3. doi: 10.1186/s12893-018-0453-9.
Intrahepatic subcapsular hematoma (ISH) is an extremely rare, life-threatening complication after laparoscopic cholecystectomy (LC). Only few cases have been reported. Herein, we reported a rare giant ISH after LC and summarized all of the reported cases.
A 32-year old woman with recurrent acute cholecystitis for one year, underwent elective LC without intra-operative complications and was discharged 2 days after operation. On the next day after discharge, she developed severe right upper abdominal pain and was sent to our emergency department. The computed tomography scan showed a 10.9 × 12.5 × 6.6 cm ISH in the right liver without free fluid and the hemoglobin dropped to 86 g/l from 127 g/l. Postoperative hemorrhagic shock and a giant ISH after LC were diagnosed. After fluid resuscitation, the hemodynamic was still unstable and the hemoglobin kept dropping. An emergency laparoscopic exploration was performed and the ISH was confirmed, however no active bleeding point was found. A drainage tube was placed under liver for early warning of rupture. Patient was discharged home 10 days after readmission.
Giant ISH is an extremely rare, life-threatening complication after LC. This case showed that the need to consider this rare complication in patients suffering abdominal pain after LC and timely and correct diagnosis and treatment were crucial to saving the lives of the patients.
肝内包膜下血肿（ISH）是腹腔镜胆囊切除术（LC）后一种极其罕见且危及生命的并发症。仅有少数病例报道。在此，我们报告了一例LC术后罕见的巨大ISH，并总结了所有已报道的病例。
一名32岁女性，复发性急性胆囊炎1年，接受择期LC，术中无并发症，术后2天出院。出院后次日，她出现右上腹剧痛，被送至我院急诊科。计算机断层扫描显示右肝有一个10.9×12.5×6.6cm的ISH，无游离液体，血红蛋白从127g/l降至86g/l。诊断为术后出血性休克及LC术后巨大ISH。液体复苏后，血流动力学仍不稳定，血红蛋白持续下降。进行了急诊腹腔镜探查，证实为ISH，但未发现活动性出血点。在肝下放了一根引流管以预警破裂。再次入院10天后患者出院。
巨大ISH是LC术后一种极其罕见且危及生命的并发症。该病例表明，对于LC术后腹痛患者需要考虑这种罕见并发症，及时、正确的诊断和治疗对于挽救患者生命至关重要。
