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Minaya Bravo et al

Three clear causes have been described like cause of liver lating heparin like associated to hematological disease such
hematoma: Small tears of the hepatic capsule after traction on multiple myeloma or leukaemia. About the management: If the
the gallbladder, puncture of the liver with the trocar when patient is stable the hematoma can be observed or drained
introducing the trocar and parenchymal injury while excision of percutanously with ultrasound guidance, and if instable
the gallbladder. 15 laparotomy is mandatory.
Others back up that this kind of complication is inherent to More studies are needed to clear this causes and determinate
the method of surgery itself. 5 is some kind of study should be accomplished in patient with
The diagnostic can be difficult till symptoms appear: Pain, risk of bleeding, as though the role of the ketorolac.
fever, vomits or shock hypovolemic.
About the management: If the patient is stable, asympto- REFERENCES
matic and the hematoma is small, a conservative therapy is the
choice. But if the hematoma has an important size so it is likely 1. Ertad BL, Rapapport WD. Subcapsular hematoma alter
that it can be reabsorbed, a percutaneous drain can be performed laparoscopic cholecystectomy, associated with ketorolac
administration. Pharmacotherapy 1994;14:613-15.
7
using under ultrasound guidance. If the patient is unstable, a 2. Pietra N, Sarli L, Costi R, Violi V. Intrahepatic subcapsular
laparotomy is mandatory. 6 hematoma: a rare postoperative complication of laparoscopic
We report about two cases: cholecystectomy. Surg Laparosc Endosc 1998; 8:304-07.
The first one was a woman with multiple myeloma ( IgA), 3. Vuilleumier H, Halkic N. Ruptured subcapsular hematoma after
who was given 30 mg intravenous ketorolac during and after laparoscopic cholecystectomy attributed to ketorolaco induced
surgery . There were no incidents during surgery and no lesions coagulopathy. Surg Endosc 2003;17:659.
were seen. The postoperative recovery was slow with non- 4. Nathason LK, Shimi S, Cuscgieri A. Laparoscopic cholecys-
specific symptoms. She went under laparotomy because of tectomy: the Dundee thecnique. Br J Surg 1991;78:155-59.
hemodynamic instability. We did not find iatrogenic lesions, 5. Alexander HC. Two unusual hemorrhagic complications during
just an important hematoma in the right hepatic lobe. It was laparoscopic cholecystectomy. Surg Laparosc Endosc.
drained and a packing made. 1993;3:346-48.
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vated some small lesions caused during surgery and not seen. 1998 Dec; 65:478-80.
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this is not clear because it was studied by hematologists and till hematoma complicating laparoscopic cholecystectomy. Sug
now they have not been able to demonstrated alteration in Laparosc Endosc. 2004; 18(5):868-70.
coagulation tests. We think that more studies about this 8. Geeta S, Shetty J. Stuart Falconer, Hakim Benyounes.
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about bleeding in this patients. We cannot discard the breaking cystectomy. Journal of laparoscopic and advanced surgical
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were seen in ultrasound previous to surgery. 9. Benoît Navez, Didier Mutter, Yves Russier, Michel Vix, Faek
In the second case, ketorolac was also administrated during Jamali, David Lipski, et al. Safety of Laparoscopic Approach
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of hemodynamic instability. But in this case, the cause seems gastrointestinal bleeding associated with the use of NSAIDs:
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his work. 2 12. Shetty GS, Falconer JS, Benyounes H. Subcapsular hematoma
We conclude, the LC is a safe method and the choice for of the liver after laparoscopic cholecystectomy . J Laparoendosc
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