Size of Splenic Subcapsular Hematoma Is Associated With Varying Outcomes of Nonoperative Management.

The presence of a splenic subcapsular hematoma (SCH) has been associated with higher rates of failure of nonoperative management (FNOM) in patients with blunt splenic injury (BSI), with rates up to 80%. We hypothesized that contemporary rates are lower. A retrospective review was conducted of patients admitted with BSI to a level I trauma center (2016-2021). Patients with SCH who had FNOM were compared to those who did not. There were 661 BSI patients, of which 102 (15.4%) had SCH. Among the SCH patients, 8 (7.8%) had FNOM. Failure of nonoperative management was higher in patients who had a SCH measuring 15 mm or greater. To the best of our knowledge, this is the largest study to date examining the relationship between SCH and FNOM. The presence of a SCH alone is not associated with a high risk for FNOM contrary to previous literature. However, SCH thickness was larger in those who failed.

Case report: Page kidney with multiple serosal effusions caused by bilateral spontaneous renal subcapsular hemorrhage.

Page kidney is caused by the perirenal or subcapsular accumulation of blood or fluid pressing on the renal parenchyma and is a rare cause of secondary hypertension. In this study, we report a case of Page caused by bilateral spontaneous subcapsular renal hematoma, the main manifestations of which were secondary hypertension, multiple serous effusions, and renal insufficiency. After admission, drug blood pressure control was ineffective. After bilateral perirenal effusion puncture and drainage were performed to relieve bilateral perirenal compression, blood pressure gradually dropped to normal, multi-serous cavity effusion (pericardial, thoracic, and abdominal effusion) gradually disappeared, and kidney function returned to normal. Secondary hypertension caused by Page kidney can be treated. When Page kidney is complicated with multiple serous effusions, the effect of antihypertensive drugs alone is poor, and early perineal puncture drainage can achieve better clinical efficacy.

Uncommon Complications of Cystoscopy: Presentations of Concurrent Perirenal Hematoma and Candida albicans Sepsis.

Subcapsular hematoma (SRH) or perirenal hematoma (PRH) can be seen after trauma, interventional radiological procedures, urological procedures, anticoagulant medications, coagulation disorders, infections, and spontaneously in some patients. Within the urological procedures, PRH can occur after percutaneous nephrolithotomy and extracorporeal shortwave lithotripsy but has only been reported a few times after cystoscopy/ureteroscopy. Here, we present the case of PRH as a complication from cystoscopy with retrograde pyelography in a patient with underlying chronic kidney disease (CKD) and an extensive surgical history for nephrolithiasis. In addition to this, our patient had a further complication of sepsis by Candida albicans, of which the source is proven to be urinary, and it appears that the fungemia was triggered during the procedure as well. The diagnosis was confirmed by abdominal computed tomography (CT), and PRH was proven to resolve with conservative management on repeat imaging months later.

The Conservative Management of an Uncommon Case of Postpartum HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) Syndrome Complicated by Liver Hematoma Causing Gastric Outlet Obstruction: A Case Report.

Hypertensive disorders of pregnancy, particularly preeclampsia, are significant contributors to maternal and fetal mortality worldwide. HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome constitutes a severe manifestation of preeclampsia. Subcapsular liver hematoma (SLH) is a rare complication of HELLP syndrome, resulting from blood accumulation between the liver parenchyma and the Glisson's capsule. We present a unique case of a pregnant patient with HELLP syndrome complicated by SLH, leading to gastric outlet obstruction (GOO). The patient's medical history, clinical presentation, diagnostic evaluation, and management are discussed. The patient, with a history of pregnancy-induced hypertension, presented with HELLP syndrome at 34 weeks of gestation. Elevated blood pressure, liver enzymes, and low platelet count were observed. Postpartum, the patient developed SLH causing GOO. Conservative management, including intravenous fluids, pain control, and a nasogastric tube, was employed. Imaging confirmed SLH and GOO. Multidisciplinary collaboration guided the treatment approach, emphasizing close monitoring, nonoperative strategies, and dietary adjustments. The patient's condition improved, and she was discharged on postpartum day 20. This case report underscores the challenges of managing HELLP syndrome complications, especially SLH-induced GOO. Early diagnosis, appropriate medical interventions, and interdisciplinary coordination are pivotal in ensuring positive outcomes. Conservative management can be effective in stable patients, but timely recognition and monitoring remain crucial for averting potential complications. This case contributes to the limited literature on managing such complex scenarios and highlights the importance of tailored strategies in multifaceted medical conditions.

Hepatic subcapsular hematoma following endoscopic retrograde cholangiopancreatography. Report of two cases.

INTRODUCTION AND IMPORTANCE: Hepatic subcapsular hematomas (HSH) are an extremely rare post-endoscopic retrograde cholangiopancreatography (ERCP) complication. Mortality exhibits disparities depending on the integrity of the hepatic capsular envelope, with ruptured HSH being associated with higher case fatality rates (2.2 % compared to 21.4 %). CASES PRESENTATION: Two clinical cases are presented concerning a 20-year-old female patient and a 40-year-old male patient, who were diagnosed with choledocholithiasis and underwent ERCP procedures with the use of a wide-bore guidewire (WBG), with the undesired result of HSH as a complication. In both scenarios, a surgical approach strategy was chosen to manage this situation. The outcome turned out to be successful in the first case, in contrast to the unfortunate death of the patient in the second case. CLINICAL DISCUSSION AND CONCLUSIONS: Conservative approaches prevail in the management of HSH, as they often present intact, resulting in a low mortality rate. However, surgical approaches are reserved for consideration in situations of hemodynamic instability that persists despite the conservative measures implemented.

Hepatic subcapsular hematoma without elevated hepatic enzyme levels: A case report.

In cases of abdominal trauma, elevated liver enzyme levels can indicate hepatic injury. To date, there are no documented reports of hepatic trauma without liver enzyme abnormalities. Herein, we present a case of hepatic subcapsular hematoma following a motor vehicle accident without abnormal findings in blood and biochemical tests over the course of time. The patient was a woman in her 20s who had collided with a passenger car while driving a light motor vehicle. She walked by herself to see a nearby after-hour doctor as an outpatient. Radiography was performed, and the patient was discharged on the same day. She was reexamined the next day and referred to our medical center due to possible hepatic injury. Her respiratory and circulatory dynamics were stable; however, she experienced mild tenderness in her right upper abdomen upon arrival. Echo-free space was observed in Morrison's and Douglas' pouches on abdominal ultrasound, and abdominal computed tomography showed a hepatic subcapsular hematoma (grade II according to the American Association for the Surgery of Trauma liver injury scale). However, blood and biochemical tests did not reveal any abnormalities. The hematoma reduced with conservative treatment after admission, and the patient was discharged on the 18th hospital day. This case indicates that hepatic injury cannot be ruled out based on serodiagnosis alone; thus, diagnostic imaging is required in cases of blunt abdominal trauma.

Severe hepatic rupture in HELLP syndrome.

OBJECTIVE: To describe the multidisciplinary approach that led to the successful management of severe hepatic rupture in HELLP syndrome at 35 weeks of gestation. CASE REPORT: The clinical course and management procedure of a 34-year-old female patient with ruptured liver due to HELLP syndrome, who was admitted with symptoms lasting about 4 hours (pain in the right hypochondrium, nausea, vomiting, flashes before the eyes) are described in the form of a case report. An acute caesarean section was performed, during which a rupture of the subcapsular hematoma of the liver was dia-gnosed. Subsequently, the patient developed hemorrhagic shock and coagulopathy with the need for repeated surgical revisions of bleeding from the rupture of the liver. CONCLUSION: Subcapsular hematoma rupture is a rare but serious complication of HELLP syndrome. This case shows the importance of early dia-gnosis and prompt termination of pregnancy in the shortest possible time in pregnancy after 34 weeks. The most fundamental factor that influenced the patient's outcome and morbidity was the management of multidisciplinary cooperation and the correct timing of individual steps.

Splenic Subcapsular Hematoma After Endoscopic Retrograde Cholangiopancreatography.

The complications of endoscopic retrograde cholangiopancreatography (ERCP) are numerous and mainly intraluminal. We present a unique case of a patient who developed splenic hematoma after ERCP. A 41-year-old woman was hospitalized for evaluation of chronic abdominal pain, for which she underwent an ERCP. The next day, the patient developed hemorrhagic shock. She was found to have a large ruptured subcapsular splenic bleed. Splenic artery embolization was performed, and the patient was stabilized. In conclusion, a high index of suspicion should be kept when managing patients presenting with unstable vital signs and/or acute anemia after ERCP.

Massive spontaneous nontraumatic subcapsular hepatic hematoma treated using arterial embolization: A case report and review of the literature.

A nontraumatic and idiopathic spontaneous subcapsular hepatic hematoma is a rare but often fatal condition. Herein, we report a case of nontraumatic progressive massive subcapsular hepatic hematoma that straddled both liver lobes and was successfully treated by repeated arterial embolization. Following treatment, the hematoma did not progress.

Bilateral Page kidney in a postpartum female: a case report.

Page kidney results from external compression of the kidney by a subcapsular hematoma and is one of the rare but treatable causes of secondary hypertension. The majority are traumatic or iatrogenic and often unilateral. Spontaneous bilateral Page kidney is rare. Case Presentation: A 35-year P1 with gestational hypertension presented with a persistent postpartum elevation of blood pressure (BP). Imaging studies revealed bilateral renal subcapsular hematoma (left>right). She was managed with an angiotensin receptor blocker initially and ultrasound-guided percutaneous drainage of the collection for the optimal control of elevated BP. Clinical Discussion: Ultrasonography and computed tomography of the kidneys are the most frequently used for diagnosing a Page kidney. Medical management with antihypertensive and regular follow-ups form the first line of treatment in Page kidneys. Percutaneous drainage, surgical decortication, laparoscopic intervention, and nephrectomy are necessary in cases of organized late hematomas. Conclusion: Spontaneous bilateral Page kidney is a rare but potentially treatable and curable form of hypertension. Percutaneous drainage is an effective method to drain the hematoma and control elevated BP.

Transcatheter arterial embolization for subcapsular hematoma of the liver.

PURPOSE: This study aimed to evaluate the technical and clinical success rates of transcatheter arterial embolization (TAE) for subcapsular hematoma of the liver. METHODS: Between January 2010 and March 2022, 34 patients underwent TAE for subcapsular hematomas of the liver. The causes of subcapsular hematoma were liver tumor rupture (n = 12), trauma (n = 12), iatrogenic complications (n = 9), and spontaneous bleeding (n = 1). The technical and clinical success rates of TAE, blood test results after TAE and additional treatments were evaluated. The patients were divided into either with or without retrograde segmental or lobar portal venous flow on angiography. Technical and clinical success rates and blood test results after TAE were compared between the two groups. RESULTS: Technical and clinical success rates were 94.1% and 73.5%, respectively. Six patients died within one month of TAE. A repeat TAE was performed in three patients. Surgical removal and hemostasis for subcapsular hematoma were done in four patients. One patient had liver failure. The retrograde portal venous flow was observed in 18 patients. The difference in technical and clinical success rates and blood test results after TAE between the two groups was statistically insignificant. CONCLUSION: TAE is an effective and safe treatment for subcapsular hematomas of the liver. The success rates of TAE and liver damage due to TAE did not differ between patients with and without retrograde portal venous flow.

A Rare Case of Page Kidney With Superimposed Infection.

Page kidney (PK) is a rare renal condition characterized by external compression of the kidney, typically by a subcapsular hematoma, leading to resistant secondary hypertension due to hypoperfusion and ischemia. This hypertension is caused by the external compression of the kidney by a chronic subcapsular hematoma that activates the renin-angiotensin-aldosterone system (RAAS) system. Hematoma formation can result from external or internal trauma. The resolution of the hematoma can take months, and, in some cases, may necessitate a nephrectomy. Unresolved subcapsular hematomas can be complicated by infection, leading to sepsis, hospitalization, and the need for surgical drainage. This report presents a unique case of a 67-year-old female with a spontaneous left renal subcapsular hematoma that did not resolve with conservative measures and was complicated by superimposed infection requiring percutaneous drainage.

Spontaneous renal cyst rupture in a female patient: A case report.

INTRODUCTION AND IMPORTANCE: Spontaneous renal cyst rupture is a rare disease process. Renal masses are heterogeneous tumors that can be benign masses to cancers. This case report aims to provide a brief overview of the renal cyst, clinical symptoms, and management considerations for similar cases. CASE PRESENTATION: A previously healthy 30-year-old complained of left back pain a few days ago. There were no abnormalities in the physical and laboratory examination, so CT Scan Abdomen with contrast was performed. It was found that there was a 7.4 cm × 7.0 cm × 7.0 cm cyst. The patients undergo conservative management. Three months later, the patient suddenly fell with severe left back pain. Due to suspicion of spontaneous rupture of the renal cyst, the patient underwent exploration and bleeding control. CLINICAL DISCUSSION: The advice to wear an abdominal corset is mandatory to protect against the renal cyst. Atraumatic renal hemorrhage has been associated with a classic Lenk's triad (hypovolemic shock, flank mass, and severe flank pain). The definitive management of renal cyst rupture is initiated by resuscitation, followed by an angiographic embolization or surgical management. CONCLUSION: The conservative management should be accompanied by advice to use an abdominal corset to protect the left flank from unintentional pressure.

Page kidney following spontaneous subcapsular hematoma immediately after kidney transplantation: a case report.

BACKGROUND: Page kidney (PK) is the occurrence of kidney hypoperfusion and ischemia due to pressure on the kidney by a subcapsular hematoma (SH), a mass, or fluid collection. SH after renal transplantation may result in kidney ischemia and graft loss. CASE PRESENTATION: We present a rare case of early spontaneous SH in an allograft kidney that led to a decrease in renal function. A 56-year-old male patient underwent deceased donor kidney transplantation. After declamping, appropriate renal perfusion and immediate diuresis were observed, with no evidence of SH. However, his urinary output abruptly decreased 6 h postoperatively. Abdominal ultrasonography showed 28 mm deep SH on transplant and the resistive index (RI) increased to 0.98-1 and diastolic flow reversal was observed. Surgical interventions were performed 2 days after transplantation, following a further decrease in urinary output. Serum creatinine decreased to 2.2 mg/dL, urinary output increased to an average of 200 cc per hour and the RI value was decreased to 0.7 on POD 7. CONCLUSION: In patients with abrupt decreased renal function after transplantation, SH should be suspected and the presence of PK should be determined using Doppler USG. In these cases, surgical intervention may avoid allograft dysfunction.

Subcapsular hematoma in a solitary kidney: successful conservative management.

Subcapsular renal hematoma (SRH) is an infrequent complication of urologic interventions but can lead to serious consequences in patients with a solitary kidney. We present our experience with conservative management of a patient with a solitary kidney and multiple medical comorbidities who developed a SRH and subsequent renal failure after nephroureteral catheter placement. Literature on the management of this unique clinical scenario is limited. Herein, we share our experience with supportive care and temporary dialysis in a medically complex patient whose outcome is complete renal recovery.

Endoscopic ultrasonography drainage and debridement of an infected subcapsular hepatic hematoma: A case report.

BACKGROUND: Endoscopic ultrasonography (EUS) has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure. EUS is now used as an alternative technique to percutaneous and surgical drainage. Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage, there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible. CASE SUMMARY: We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma (SHH) of the left lobe following percutaneous biliary drainage. After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn't withstand surgery, we conducted a EUS drainage and debridement of the SHH. Using a lumen apposing metal stent (LAMS) by a transgastric approach, we were able to gain endoscopic access to the SHH. With our experience in the debridement of walled off pancreatic necrosis using this technique, we were confident it was the right approach. After four debridement sessions, the computed tomography scan showed a clear regression of the SHH. CONCLUSION: To our knowledge, this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.

A case of percutaneous cryoablation complicated by subcapsular hemorrhage managed conservatively.

Herein, we report a patient who underwent percutaneous cryoablation for suspected renal cell carcinoma and developed a subcapsular hematoma with numerous pseudoaneurysms and dramatic structural deformity. Despite the severity suggested by the radiologic presentation, a conservative management approach was selected due to the patient's favorable hemodynamic status. This resulted in a positive outcome as alternative treatment options would have resulted in loss of the organ.

Renal Subcapsular Hematoma Due to Reperfusion Injury Following Renal Angioplasty in Fibromuscular Dysplasia: A Dilemma in Diagnosis and Management.

Fibromuscular dysplasia (FMD) is a potentially treatable cause of renovascular hypertension and it typically affects young females. FMD usually involves distal two-thirds of the renal artery and percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice for FMD with resistant hypertension. PTRA is a safe procedure with minimal complications. However, renal subcapsular hematoma due to reperfusion injury is a rare complication following PTRA. A 32-year-old male presented with resistant hypertension. Arteriography of renal arteries showed >90% stenosis of ostial-proximal left renal artery with a string of beads appearance. PTRA was performed with the deployment of a 4 x 10 mm balloon-expandable stent in the stenotic segment of the left renal artery. However, computed tomography of the abdomen revealed massive left perinephric subcapsular hematoma without peritoneal collection. As the patient was hemodynamically stable, no invasive intervention was done, and discharged without requiring any anti-hypertensive medication. Putative reperfusion injury may provoke bleeding complications after renal angioplasty in a case of long-standing renal artery stenosis and can be managed conservatively with close surveillance in certain cases.