Massive subcapsular hepatic haematoma after laparoscopic cholecystectomy managed by transarterial embolization

Abstract Subcapsular hepatic haematoma is a rare, potentially life-threatening complication of laparoscopic cholecystectomy. A previously well woman in her 30s developed severe right upper quadrant pain and vomiting immediately after an apparently uncomplicated laparoscopic cholecystectomy. Multiphase computed tomography the next day showed a haematoma exceeding 19 cm with active bleeding from segments IVb and V. Angiography identified multifocal bleeding from hepatic arterial branches, including an accessory branch from the gastroduodenal artery. Selective gelatin-sponge embolization achieved angiographic haemostasis. Despite the haematoma subsequently rupturing into the peritoneal cavity and haemoglobin falling to 58 g/L, the patient remained haemodynamically stable and was managed with blood transfusion and surveillance without reoperation or drainage. This case supports early vascular imaging for disproportionate postoperative pain and physiology-guided management after embolization.