Survival After Ruptured Spontaneous Hepatic Subcapsular Hematoma Following Heparin Initiation for Submassive Pulmonary Embolism

Hepatic subcapsular hematomas (HSHs) are rare outside the context of trauma, endoscopic retrograde cholangiopancreatography, and pregnancy. Ruptured HSHs present with abdominal pain and hypotension, with high mortality. We present the patient case of a 69-year-old man readmitted with deep venous thrombosis and pulmonary embolus after uncomplicated laparoscopic prostatectomy. Soon after receiving heparin, he experienced acute abdominal distention and right upper quadrant pain. A large ruptured subcapsular hematoma with focal active bleeding was identified and eventually controlled surgically. We highlight that HSHs can complicate anticoagulant therapy. Awareness and prompt intervention can be lifesaving.