title: Subcapsular hematoma of the liver due to intercostal anesthesic blockage after cholecystectomy: case report.
abstract: The subcapsular hematoma of the liver (SHL) are the results of injuries such as liver needle biopsy, liver trauma, pregnancy illnesses, parasitic diseases and others. The approach of these lesions depends on the various clinical presentations of subcapsular hematoma of the liver because it may be small with minimal clinical repercussion, managed only by ultrasound observation. In some situations the SHL may present large dimensions with hemodinamic instability. A case of subcapsular hematoma of the liver secondary to anesthetic intercostal blockade to control the postoperative pain after cholecystectomy is reported. A 34-year-old woman was submitted to intercostal anesthetic blockade after cholecystectomy for treatment of cholelithiasis. The blockade evolved with pain in right flank followed of mucocutaneous pallor and fall of the haematocrit and hemoglobin levels. At relaparotomy, subcapsular hematoma of the liver was proven and tamponed with compresses. The patient had good postoperative evolution being discharged from hospital, after removing the compresses. In conclusion, the intercostal anesthesic blockade, as any other medical procedure, is not exempt of complications. Therefore, it must be carried through in well selected cases; Anyway nowadays, there are efficient drugs for the control of postoperative pain.
authors.affiliation: Division of General Surgery, Department of Surgery, Hospital Dom Luiz I da Beneficente Portuguesa do Pará, Belém, Pará, Brazil.
authors.forename: A L
authors.initials: AL
authors.lastname: Santos Rodrigues
authors.forename: A C
authors.initials: AC
authors.lastname: Silva Santana
authors.forename: L
authors.initials: L
authors.lastname: Crociati Meguins
authors.forename: D
authors.initials: D
authors.lastname: Felgueiras Rolo
authors.forename: M
authors.initials: M
authors.lastname: Lobato Ferreira
authors.forename: C A
authors.initials: CA
authors.lastname: Ribeiro Braga
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015552:Injections, Intralesional / Q000009:adverse effects*; D007367:Intercostal Nerves; D008107:Liver Diseases / Q000209:etiology* / Q000628:therapy; D010149:Postoperative Pain / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine