N. Hirata et al., Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones, J GASTRO, 34(6), 1999, pp. 713-716
We present a patient with complication of huge hepatic subcapsular hematoma
after extracorporeal shock wave lithotripsy (ESWL) for pancreatic lithotri
psy. The hematoma measured 78-110 mm. Angiography showed a subcapsular hema
toma, rather than a hematoma in the liver. In the arterial phase, the dista
l end of the small vessel showed spotty opacification similar to microaneur
ysma, suggesting that it was an injury caused by separation of the liver an
d its capsule, caused by the shock waves. The portal vein and hepatic vein
were normal. After 8 weeks of conservative therapy, the hematoma was gradua
lly absorbed and the patient was discharged. Eight months after the acciden
t, the hematoma had decreased to 40 mm in size. After 20 months, it was com
pletely absorbed. The reported rate of renal subcapsular hematoma after ESW
L for renal or ureter stones is 0.1%-0.7%. To date, however, only five case
s of hepatic subcapsular hematoma after right renal stone disintegration ha
ve been reported. This is the first report of hepatic subcapsular hematoma
after ESWL for pancreatic stones.