Liver injury related to extracorporeal shock wave lithotripsy in a quadriplegic patient

Abstract

ESWL-related complications are classified as those associ-A 30-year-old woman, a complete quadriplegic at the level of C5 since 1991, presented with recurrent stone ated with poor fragment clearance and those related to injury of the target organ or adjacent tissues. Although disease in the right kidney, requiring ESWL retreatment; 3000 shock waves (maximum energy 17.2 kV) were life-threatening injuries are extremely rare after ESWL, fatal outcomes have been reported [1]. Liver damage, delivered as an outpatient procedure using the Siemens Lithostar 2000 lithotripter. Two days after lithotripsy observed in experimental studies and clinical practice, the patient was admitted as an emergency with abdominal pain and signs of internal bleeding. Other causes of recent abdominal trauma were excluded by history and physical examination. CT revealed a subcapsular hepatic haematoma with focal parenchymal haemorrhage and peritoneal liquid collections in perisplenic and paracolonic spaces (Fig. 1), as well as bilateral pleural eCusions. Subcapsular haematoma and rupture of liver tissue with frank bleeding were found intraoperatively. The bleeding required ligation of the right branch of the hepatic artery; no hepatic tissue was resected. Neither CT nor surgical exploration showed renal injury (Fig. 2). Only a minor hepatic subcapsular haematoma with no sign of parenchymal necrosis was revealed by CT 4 months after surgical treatment (Fig. 3). Liver function tests were within the normal range.

Subcapsular liver hematoma after extracorporeal shock wave lithotripsy, a rare complication

“…When a hematoma appears patients usually present with pain that persists despite administrations of analgesics, other symptoms include mild fever and syncope [7]. Diagnosis is challenging as a high index of suspicion is usually needed [7, 8].…”

“…When a hematoma appears patients usually present with pain that persists despite administrations of analgesics, other symptoms include mild fever and syncope [7]. Diagnosis is challenging as a high index of suspicion is usually needed [7, 8]. Supportive care is the favored treatment for liver hematomas after ESWL, close follow up is vital and blood transfusion should be immediately started when signs of hypovolemic shock are detected [8].…”

“…As our patient experienced. Embolization or surgical approaches should be considered in severe cases that do not respond to transfusion and supportive care [7, 9].…”