Diagnosis and treatment of subcapsular hemorrhage after liver tumor ablation

Objective To investigate the diagnosis and treatment of subcapsular hemorrhage caused by liver tumor ablation. Methods A retrospective analysis was performed for the clinical data of 1596 patients who underwent CT-guided liver tumor microwave/radiofrequency ablation in Beijing You An Hospital, Capital Medical University, from January 2016 to July 2017, and among these patients, 20 experienced subcapsular hemorrhage after ablation. The clinical data of the 20 patients were collected, and their diagnostic method, treatment regimen, and prognosis were analyzed. The chi-square test was used for comparison of categorical data between groups. Results Among the 638 patients who underwent microwave ablation, 10 experienced subcapsular hemorrhage, resulting in an incidence rate of 1. 57%; among the 958 patients who underwent radiofrequency ablation, 10 experienced subcapsular hemorrhage, resulting in an incidence rate of 1. 04%; there was no significant difference in the incidence rate of this complication between the two groups ( χ2= 0. 848, P = 0. 357) . Among the 20 patients, 17 were found to have spillage of the contrast media on contrast-enhanced CT immediately after ablation; 3 had negative findings on contrast-enhanced CT immediately after ablation and were found to have hemorrhage within 24 hours after ablation, and transcatheter arterial embolization ( TAE) was performed after a definite diagnosis was made by emergency CT. Of all 20 patients with hemorrhage, 2 were complicated by gallbladder hemorrhage; 19 underwent TAE, among whom 6 had the leakage of the contrast agent on angiography. The patients were followed up for 1-3 months, and all of them recovered well; there were no deaths. Conclusion Subcapsular hemorrhage is one of the serious complications after liver tumor ablation, and contrast-enhanced CT immediately after ablation can find most cases of bleeding. Patients with mild hemorrhage can be given symptomatic and conservative treatment first, and TAE should be performed as early as possible for patients with active arterial hemorrhage or who do not respond to conservative treatment.