Aliabusunoon Mamoun, Baroom Abdulrahman, Abdulghafar Hossam, Alssied Hala
Faculty of Medicine, Department of Internal Medicine, University of Gezira, Gama'a, 21111 P.O. Box 20, Wad Medani, Gezira, Sudan.
Department of General Surgery, King Salman bin Abdulaziz Medical City, 8004 Sulayman Bin Othman, 42319 Mahzur, Al-Medinah Al-Munawwarah, Saudi Arabia.
J Surg Case Rep. 2024 Aug 9;2024(8):rjae498. doi: 10.1093/jscr/rjae498. eCollection 2024 Aug.
A 41-year-old male, with a clear medical background, underwent laparoscopic cholecystectomy for uncomplicated acute cholecystitis. No complications were observed intraoperatively. Second day after operation, the patient developed intense right upper quadrant pain, dizziness, and hypotension with a hemoglobin drop to 8.8 g/dl. Subsequently, an urgent computed tomography was done, which identified subcapsular hepatic with an intraparenchymal hematoma, and therefore, the diagnosis of intrahepatic subcapsular hematoma (ISH) was made. After fluid resuscitation and blood transfusion, the hemodynamic status became stable with no further hemoglobin decline noted. Further serial imaging was conducted and showed no signs of expansion nor intra-abdominal hemorrhage and the conservative line of management was carried on. Nine days later, the patient was discharged home. This report emphasizes the importance of close monitoring of patients who undergo LC and the possibility of ISH, although being rare, in those who report acute abdominal pain and hemodynamic instability after LC.
一名41岁男性,有明确的病史,因单纯性急性胆囊炎接受了腹腔镜胆囊切除术。术中未观察到并发症。术后第二天,患者出现右上腹剧痛、头晕和低血压,血红蛋白降至8.8 g/dl。随后进行了紧急计算机断层扫描,发现肝包膜下实质内血肿,因此诊断为肝包膜下血肿(ISH)。经过液体复苏和输血,血流动力学状态稳定,血红蛋白未进一步下降。进一步的系列影像学检查显示没有扩大迹象,也没有腹腔内出血,继续采取保守治疗方案。九天后,患者出院回家。本报告强调了对接受LC手术的患者进行密切监测的重要性,以及在LC术后出现急性腹痛和血流动力学不稳定的患者中发生ISH的可能性,尽管这种情况很少见。