Hepatic subcapsular haematoma in a premature newborn

Abstract

SUMMARYSubcapsular haematoma of the liver rarely occurs in neonates and the diagnosis is often missed or delayed. It is a catastrophic condition that can be caused by maternal, placentar or fetal factors. A high index of suspicion is essential for early identification and stabilisation of babies with such a pathology. In a newborn with hypovolemic shock and abdominal distension, haemoperitoneum should be suspected and, along with exclusion of other aetiologies, supportive therapy should be instituted. The hepatic subcapsular haematoma has a non-specific presentation, and should be considered in very low birth weight infants with hypovolemic shock. Abdominal ultrasonography is the investigation of choice. It can delineate the lesion well, differentiate it from neoplasms, rule out rupture and aid in serial follow-up. We report a premature newborn who had this uncommon condition in the early neonatal period and survived without sequelae. BACKGROUND

Subcapsular Liver Hematoma—A Life-Threatening Condition in Preterm Neonates—A Case Series and Systematic Review of the Literature

“…In the cases of SHL acute rupture, the infant presents with non-specific clinical signs of abrupt massive bleeding, such as hypovolemia and shock. Neonates with slowly progressing hematomas, present with paleness, jaundice, irritability and respiratory distress [ 21 ], and since the incidence is very low, the diagnosis is usually delayed [ 4 ]. Patients are usually very premature, in a critical condition since birth [ 17 ].…”

“…A total of 39 articles reported 433 cases SLH, in neonatal population [ 2 , 3 , 4 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The characteristics of the reported cases are summarized in Table S1 .…”

Unexpected extensive hemorrhage from a subcapsular hematoma of the liver during emergent laparotomy in a premature neonate

“…Contractility of the hepatic vein is also poor. Premature or very-low-birth-weight infants are more vulnerable to immaturity; thus, even if there is no trauma, a hematoma may occur naturally 1…”

“…Abnormal conditions during labor such as a breech presentation or oversized infants, increase the incidence of trauma. Traumatic umbilical venous catheterization and cardiopulmonary resuscitation have also been reported to induce hepatic rupture 1,2,6. Moreover, many cases of SHL are related to coagulopathy.…”

“…A subcapsular hematoma of the liver (SHL) is a rare disease wherein blood accumulates under Glisson’s capsule of the liver. It should be distinguished from an intrahepatic hematoma that occurs in the liver parenchyma and in which the amount of bleeding is limited 1. Subcapsular hematoma of the liver in neonates is rare with few reported cases in the literature.…”