eP99 Intrahepatic subcapsular hematoma (ISH) after laparoscopic cholecystectomy: a case report and literature review

Background This is an extremely rare but serious life-threatening complication following laparoscopic cholecystectomy. Case report A morbidly obese women who underwent an uneventful laparoscopic cholecystectomy as an emergency developed severe pain and severe haemorrhagic shock the following day. She was unstable to go for any imaging and hence rushed to theatre for a re-laparoscope which showed a massive intrahepatic subcapsular haematoma of the liver. A non-suction drain was left in the sub hepatic space and intra and postoperatively had blood transfusion, initial few days of inotropic support and close monitoring for a few days in critical care unit. She had regular serial CT scans for monitoring the haematoma which gradually resolved in 6 months. Discussion The cause in our patient was not clear but it may be a degree of iatrogenic injury which could have been compounded by the fatty liver. Fortunately, the capsule was intact and also on monitoring the haematoma it was stable in size and did not need any further intervention. Intrahepatic subcapsular haematoma is extremely rare condition after cholecystectomy. All reported cases are females. The cause of this not clear but it has been speculated that it may be related to iatrogenic injury during surgery, NSAIDs, haemangiomas, aberrant liver vascularisation. Imaging is needed to establish a diagnosis if patient is stable. Management includes blood transfusion, close monitoring, strict blood rest. Intervention such as radiological drainage or laparoscopy/ laparotomy depending on the patient's progress and clinical need. The cause of haematoma was not clear.