Subcapsular hepatic hematoma after extracorporeal shock wave lithotripsy for ureteral stone successfully treated with...

Subcapsular hepatic hematoma is a rare complication of extracorporeal shock wave lithotripsy performed for ureteral stones, and reports describing severe hemorrhage requiring endovascular treatment are limited. A 45-year-old man with hypertension and obesity underwent extracorporeal shock wave lithotripsy for an asymptomatic right upper ureteral stone at a referring facility. Later that night, he developed abdominal pain and was transported to our emergency department the next day. Laboratory testing demonstrated anemia and elevated lactate. Contrast-enhanced computed tomography revealed a hepatic subcapsular hematoma along the anterior-to-inferior aspect of the right hepatic lobe, with multiple punctate enhancing nodules on the liver surface and a large volume of hemorrhagic ascites. Emergency angiography demonstrated pseudoaneurysm-like findings in distal branches supplying hepatic segments V and VI, and these lesions were treated with selective embolization using gelatin sponge particles. After embolization, his hemodynamics stabilized, hemoglobin levels did not further decline, and blood transfusion was not required. Follow-up contrast-enhanced computed tomography performed 6 days after embolization showed no contrast extravasation and decreased ascites, and the patient was discharged. Interval computed tomography confirmed gradual hematoma resolution. Clinicians should recognize subcapsular hepatic hematoma as a rare but potentially life-threatening complication after extracorporeal shock wave lithotripsy. In cases with substantial hemorrhage, prompt imaging evaluation and endovascular hemostasis can be effective.