Case report: spontaneous liver hematomas.

Abstract

Introduction: spontaneous hepatic hematomas (SHH) are a rare clinical entity that requires immediate medical attention as they cause intra-abdominal hemorrhage that, if left untreated, will progress to hemorrhagic shock and death. Characterized by the formation of a hematoma in the liver parenchyma without apparent traumatic cause, its pathogenesis is multifactorial and usually involves vascular alterations, coagulopathies or underlying liver diseases. Clinical case: a 42-year-old female patient with a history of arterial hypertension and long-term use of oral contraceptives presented with intense abdominal pain in the right hypochondrium. Abdominal computed tomography (CT) revealed the presence of multiple hepatic hematomas. Despite initial conservative management, the patient developed bilithorax. Conclusion: SHH represents a medical challenge; the high associated mortality underlines the importance of early diagnosis and multidisciplinary management. Despite these problems, SHEs have never been studied in depth, probably due to their uniqueness and the fact that many publications are small series of less than five patients. This case report of spontaneous hepatic hematomas aims to draw attention to the importance of early recognition and adequate treatment of SHEs, highlighting the need for a multidisciplinary approach to obtain optimal results. Diagnosis is based primarily on imaging findings, with CT being the method of choice. Treatment is individualized, depending on the severity of the clinical picture, and therapeutic options include conservative management, arterial embolization, and surgery.