Chronic Expanding Hematoma in the Liver Presenting with Intraperitoneal Hemorrhage: A Case Report and Literature...

Chronic expanding hematoma (CEH) is a rare condition in which a hematoma gradually enlarges over time after trauma or surgery. Hepatic CEH is extremely rare, and its preoperative differentiation from malignant tumors is difficult. Here, we report a case of CEH complicated by intraperitoneal hemorrhage.

A man in his 60s presented with epigastric pain. Contrast-enhanced CT revealed a 32-mm mass lesion in segment 2 of the liver and intraperitoneal hemorrhage with contrast extravasation adjacent to the lesion. Ruptured hepatocellular carcinoma was initially suspected, and emergency transcatheter arterial embolization achieved hemostasis. Follow-up CT demonstrated enlargement of the encapsulated hematoma near the embolized lesion. Left lateral sectionectomy was performed 33 days after embolization. Intraoperatively, a 10-cm cystic lesion with dense adhesions was identified in the left lateral section. Histopathological examination revealed a fibrous cyst wall with capillary proliferation and aggregates of histiocytes without malignant cells, leading to the diagnosis of hepatic CEH. The postoperative course was uneventful, and the patient was discharged on POD 8.

CEH in the liver is rare, and its differentiation from malignant tumors is challenging; therefore, further accumulation of cases is required to establish optimal diagnostic and therapeutic strategies. If CEH in the liver is complicated by intraperitoneal hemorrhage, as in this case, surgical resection may need to be considered proactively.