Hepatoportal fistula complicated by subcapsular liver hematoma post-cholecystectomy. unusual biliary tract injury: case report

Abstract

Introduction: Subcapsular hepatic hematoma (SCH) is a rare complication following laparoscopic cholecystectomy (LC), with an incidence of 0.08–2%. It primarily originates from lacerations of Glisson's capsule or excessive traction during surgery. Hepatic arterioportal fistulas (HAFs) are abnormal connections between the hepatic artery and the portal vein, usually acquired, and their diagnosis is complex due to nonspecific symptoms. Objective: To describe the frequency, diagnosis, and therapeutic management of SCH and HAFs as postoperative complications of LC. Case report: A 29-year-old woman with no prior medical history underwent LC for gallstones and presented with hemodynamic instability in the immediate postoperative period. Imaging studies revealed subcapsular hepatic hematoma in segments VII and VIII. Percutaneous drainage was performed, but it failed, and the hematoma volume increased. After a second unsuccessful surgical drainage, hepatic arteriography was performed, diagnosing a hepatoportal fistula. Subsequent angioembolization of the right hepatic artery resulted in the definitive resolution of both complications. Conclusions: Traumatic laceration of Glisson's capsule or excessive traction of the gallbladder fundus during cholecystectomy are the main technical factors in the development of postoperative hepatosubcapsular hematoma (HSH). HSH and hepatoportal fistula (HFHP) are uncommon pathologies, and currently, there are no standardized protocols for managing them as postoperative complications. However, percutaneous drainage and selective angioembolization are considered the gold standard for treating these surgical complications.