An Interesting Case of a Large Spontaneous Sub Capsular Hematoma of Liver

Abstract

Spontaneous sub capsular hematoma of the liver is a rare clinical condition, more commonly seen in pregnancy when associated with pre-eclampsia and HELLP (Hemolysis Elevated Liver Enzymes and Low Platelets) Syndrome. It is also reported in patients with gross anatomical liver lesions, coagulopathy, bleeding disorders and those on anti-coagulants. We report a 44-year-old female patient who presented with sudden onset of diffuse abdomen pain. Computed Tomography (CT) scan of abdomen showed spontaneous large sub capsular hematoma of liver. Our patient did not have any of the above-mentioned conditions. To our knowledge and as per the literature reviewed, this is one of the largest sub capsular hematoma of the liver ever reported. Spontaneous sub capsular hematoma of the liver is an infrequent occurrence in clinical practice. It is an accumulation of blood between the hepatic parenchymal tissue and its overlying Glisson capsule thereby stretching it and causing abdominal pain and discomfort. Liver hematoma does not have a distinctive clinical presentation and the symptoms with which patient present to the hospital include abdominal discomfort and right upper abdominal pain. Prompt recognition may be entertained in patients presenting with sudden onset abdominal pain and CT scan done early in doubtful cases may aid in early diagnosis. Patients can be treated with non-operative management in cases of hemodynamic stability with vigilant monitoring.