Spontaneous hepatic subcapsular hematoma

ABSTRACT

A 47-year-old male presented with right hypochondrial pain radiating to the right shoulder associated with nausea and vomiting along with fever. Primary investigations showed significant neutrophilic leukocytosis. Initial impression was liver abscess. Further evaluation suggested the presence of liver cirrhosis complicated by hepatic subcapsular hematoma. Patient was managed conservatively at the beginning but he continued to deteriorate and hematoma increased in size. Hepatic artery angiography showed no signs of active bleeding. Later on his condition deteriorated further due to sudden intraperitoneal hemorrhage, which did not respond to emergency surgery or resuscitative measures. Operative finding and histopathology findings were consistent with hepatocellular carcinoma