Ultrasound in Emergency Medicine| Volume 45, ISSUE 4, P598-601, October 2013

Subcapsular Liver Hematoma after Colonoscopy Diagnosed by Emergency Department Bedside Ultrasonography



      Hepatic subcapsular hematoma is an uncommon cause of right upper quadrant pain in the Emergency Department. It must be recognized early, as large volumes of acute blood loss and rupture into the peritoneum carry significant morbidity and mortality. In the absence of gallbladder disease, the differential diagnosis should include liver pathology. Bedside ultrasonography can be used to identify such lesions.


      To discuss the presentation, evaluation, and management options of hepatic subcapsular hematoma.

      Case Report

      We report a case of a 30-year-old woman who presented with the chief complaint of right upper quadrant pain radiating to the right scapula 6 h after a screening colonoscopy for intestinal polyps. Emergency physician-performed bedside ultrasound revealed a large hyperechoic mass in the right lobe of the liver. Radiology-performed comprehensive ultrasound and subsequent computed tomography scan of her abdomen and pelvis revealed a subcapsular hematoma without intestinal perforation.


      In a patient with undifferentiated right upper quadrant abdominal pain, bedside ultrasonography is a rapid and effective modality in the diagnosis of liver masses, including subcapsular hematoma.


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        • Bis K.A.
        • Waxman B.
        Rupture of the liver associated with pregnancy. A review of the literature and report of two cases.
        Obstet Gynecol Surg. 1976; 31: 763-773
        • Manas K.J.
        • Welsh J.D.
        • Rankin R.A.
        • et al.
        Hepatic hemorrhage without rupture in preeclampsia.
        N Engl J Med. 1985; 312: 424-426
        • Ndzengue A.
        • Hammoudeh F.
        • Brutus P.
        • et al.
        An obscure case of hepatic subcapsular hematoma.
        Case Rep Gastroenterol. 2011; 5: 223-226
        • Zidouh S.
        • Belymani L.
        • Kouach J.
        • et al.
        Subcapsular hepatic hematoma revealed by hemorrhagic shock in a preeclamptic patient.
        J Emerg Med. 2012; 42: 585-586
        • Wicke C.
        • Pereira P.L.
        • Neeser E.
        • et al.
        Subcapsular liver hematoma in HELLP syndrome: Evaluation of diagnostic and therapeutic options—a unicenter study.
        Am J Obstet Gynecol. 2004; 190: 106-112
        • Choi S.K.
        • Jin J.S.
        • Cho S.G.
        • et al.
        Spontaneous liver rupture in a patient with peliosis hepatis: a case report.
        World J Gastroenterol. 2009; 15: 5493-5497
        • Doganay S.
        • Kocakoc E.
        • Balaban M.
        Nontraumatic hepatic hematoma caused by Wegener's granulomatosis: an unusual cause of abdominal pain.
        N Z Med J. 2010; 123: 73-78
        • Behanwala K.A.
        • Tisdall M.
        • Habib N.H.
        • et al.
        Spontaneous bilobar subcapsular hematoma of the liver while undergoing anticoagulation therapy: our experience and review of the literature.
        Int Surg. 2004; 89: 212-216
        • Shibuya K.
        • Midorikawa Y.
        • Mushiake H.
        • et al.
        Ruptured hepatic subcapsular hematoma following laparoscopic cholecystectomy: report of a case.
        Biosci Trends. 2010; 4: 355-358
        • Orellana F.
        • Irarrazaval J.
        • Galindo J.
        • et al.
        Subcapsular hepatic hematoma post ERCP: a rare or an underdiagnosed complication?.
        Endoscopy. 2012; 44: E108-E109
        • Stine J.G.
        • Liss G.
        • Lewis J.H.
        The safety of same-day endoscopy and percutaneous liver biopsy.
        Dig Dis Sci. 2011; 56: 1201-1206
        • Gordetsky J.
        • Hislop S.
        • Orloff M.
        • et al.
        Subcapsular hepatic hematoma with right hepatic vein thrombosis: a complication of shock wave lithotripsy.
        Can Urol Assoc J. 2008; 2: 61-63
        • McGrath F.P.
        • Lee S.H.
        • Gibney R.G.
        • et al.
        Hepatic subcapsular hematoma: an unusual complication of biliary lithotripsy.
        AJR Am J Roentgenol. 1990; 154: 1015-1016
        • Strate L.L.
        • Naumann C.R.
        Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding.
        World J Gastroenterol. 2012; 18: 1185-1190
        • Casillas V.J.
        • Amendola M.A.
        • Gascue A.
        • et al.
        Imaging of nontraumatic hemorrhagic hepatic lesions.
        Radiographics. 2000; 20: 367-378
        • Chaung C.C.
        • Wu S.F.
        • Chen A.C.
        • et al.
        Pitfalls in a sonographic diagnosis of liver abscess in children.
        Pediatr Neonatol. 2012; 53: 98-104
        • Chakrabarti I.
        • Giri A.
        • De A.
        • et al.
        Radio-pathological diagnosis of hepatobiliary ascariasis: a rare entity.
        J Cytol. 2011; 28: 114-116
        • Lee J.H.
        • Chae H.B.
        • Seo E.K.
        • et al.
        Successful hemostasis with recombinant activated factor VII in a patient with massive hepatic subcapsular hematoma.
        Case Rep Gastroenterol. 2009; 3: 10-15
        • Mouratidis B.
        • Antonio G.
        Sonographic diagnosis of subcapsular liver hematoma mimicking tumor in a neonate.
        J Clin Ultrasound. 2000; 28: 53-57