Symptomatic intrahepatic subcapsular hematoma-derived liver cyst following laparoscopic cholecystectomy: a case...

Intrahepatic subcapsular hematoma (ISH) is a rare complication following laparoscopic cholecystectomy (LC). Although most reported cases occur in the early postoperative period and resolve with conservative treatment, the management of chronic or refractory ISH remains unclear. We report a delayed, symptomatic cystic lesion that developed from postoperative ISH and was treated laparoscopically.

A 70-year-old man receiving aspirin for a previous myocardial infarction underwent LC for cholelithiasis and cholecystitis. Aspirin was resumed on postoperative day (POD) 2. On POD 4, decreased hemoglobin and elevated C-reactive protein levels prompted computed tomography, which revealed an ISH extending from the gallbladder bed to the right hepatic lobe. The patient was initially managed conservatively. On POD 105, a hepatic cystic lesion approximately 15 cm in diameter was detected, without laboratory evidence of inflammation. On POD 380, worsening abdominal pain and elevated inflammatory markers suggested secondary infection. Percutaneous drainage on POD 385 produced only temporary improvement, and the lesion recurred. Laparoscopic fenestration was therefore performed on POD 510. Indocyanine green fluorescence imaging clearly distinguished the non-fluorescent cyst wall from the surrounding hepatic parenchyma and facilitated safe resection. The postoperative course was uneventful, and no recurrence was observed during 1 year of follow-up.

ISH following LC may evolve over several months into a chronic cystic lesion and subsequently become infected. Long-term follow-up should be considered for persistent or enlarging ISH. When conservative management and percutaneous drainage fail, laparoscopic fenestration with indocyanine green fluorescence imaging may provide a safe and definitive treatment option.