Spontaneous Hepatic Capsular Avulsion Requiring Emergency Embolisation

Spontaneous Hepatic Capsular Avulsion Requiring Emergency Embolisation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Spontaneous Hepatic Capsular Avulsion Requiring Emergency Embolisation Darragh Waters, Jack Alderson, Douglas Mulholland This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7310631/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Dec, 2025 Read the published version in CVIR Endovascular → Version 1 posted 4 You are reading this latest preprint version Abstract Spontaneous hepatic haemorrhage is a rare and potentially fatal condition, most often associated with trauma or underlying liver disease. This case describes a 78-year-old woman on rivaroxaban who presented with haemodynamic shock due to a spontaneous subcapsular liver haematoma with capsular rupture and pseudoaneurysm formation. Imaging revealed multiple abnormal vessels without a single bleeding point. Trans arterial embolisation with Gelfoam was performed, achieving haemostasis without significant hepatic infarction. The patient remained stable post-procedure, with normalisation of liver function tests and no underlying liver neoplasm on follow-up imaging. This case underscores the importance of early diagnosis and multidisciplinary intervention. Temporary embolic agents such as Gelfoam offer effective haemostasis with lower risk of long-term hepatic injury in patients with diffuse microvascular disruption. Spontaneous hepatic haemorrhage Subcapsular liver haematoma Pseudoaneurysm Trans arterial embolisation Gelfoam embolisation Rivaroxaban-related bleeding Hepatic artery embolisation Interventional radiology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Spontaneous hepatic haemorrhage is an uncommon but potentially fatal condition, typically associated with underlying liver pathology, trauma, or anticoagulation. Subcapsular haematomas may progress to capsular rupture and haemoperitoneum, with high associated morbidity and mortality. Prompt diagnosis and multidisciplinary management are essential to prevent further haemorrhage and organ compromise. This case highlights a rare presentation of spontaneous subcapsular liver haematoma with capsular rupture and pseudoaneurysm formation in a patient anticoagulated with rivaroxaban, successfully managed with trans arterial embolisation. Case Report A 78-year-old woman presented to the emergency department with sudden-onset abdominal pain, distension, and nausea. There was no history of trauma. Her medical history was significant for atrial fibrillation, and she was anticoagulated with Rivaroxaban. On arrival, she was tachycardic and hypotensive, with a systolic blood pressure of 60 mmHg. Her haemoglobin level had dropped to 6.4 g/dL, necessitating blood transfusion. Portal venous phase computed tomography (CT) of the abdomen and pelvis revealed a large subcapsular haematoma in segments 5/6 of the liver with rupture of the overlying capsule and associated haemoperitoneum. Triple-phase CT of the abdomen demonstrated multiple abnormal vessels underlying the haematoma, suspicious for active haemorrhage. Following multidisciplinary input from general surgery, general medicine, and intensive care, the patient was transferred to interventional radiology for hepatic angiography and embolisation. Via a right common femoral artery approach, a 5 French C2 Glide catheter was used to select the coeliac artery and advanced into the right hepatic artery. Digital subtraction angiography revealed no active haemorrhage but demonstrated innumerable pseudoaneurysms along the capsular surface of the right hepatic lobe. Embolisation of the right hepatic artery was performed to stasis using Gelfoam. Post-procedurally, the patient was transferred to the intensive care unit for monitoring. She remained haemodynamically stable and did not require further transfusion. Follow-up multiphase CT showed a stable haematoma with no residual perfusion of the pseudoaneurysms, though small areas of hepatic ischaemia were noted. Serial liver function tests post-procedure became mildly deranged with elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Bilirubin remained normal. Both ALT and AST normalised after one week. Elective outpatient magnetic resonance imaging (MRI) of the liver was performed six weeks post procedure which showed reduction in size of the liver haematoma and no underlying liver lesions or infarction. Discussion Spontaneous subcapsular haematoma of the liver is a rare and life-threatening condition, typically associated with underlying liver lesions or occurring in the context of HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets) during pregnancy [6]. In the obstetric population, mortality from a ruptured subcapsular haematoma has been reported to range between 39% and 59% [3]. As the haematoma enlarges, shear forces may cause avulsion of the hepatic capsule from the underlying parenchyma, leading to tearing of intrahepatic or subcapsular arteries. This disruption in arterial wall integrity allows blood to escape into the surrounding tissue and form contained haematomas, known as pseudoaneurysms. Unlike true aneurysms, these lack all three arterial wall layers and are walled off by surrounding parenchyma or capsule. The resulting high-pressure arterial flow within these fragile structures increases the risk of ongoing or delayed haemorrhage. In this patient, the presence of innumerable pseudoaneurysms along the capsular surface of the right hepatic lobe likely reflects diffuse microvascular disruption secondary to subcapsular haematoma expansion and capsular rupture. Notably, the patient had a normal outpatient MRI two months prior to presentation, with no evidence of underlying liver disease or lesion. Spontaneous hepatic haematoma is exceedingly rare in patients without predisposing liver pathology. The estimated annual risk of spontaneous major haemorrhage while taking rivaroxaban is approximately 1%, only marginally higher than with aspirin [6]. Management options for acute liver haemorrhage include conservative measures, angiography with embolisation and surgery. Hepatic artery embolisation is an effective treatment with one study demonstrating success rates of up to 94% [4]. In this case, the presence of numerous pseudoaneurysms without a single identifiable bleeding point made permanent embolic agents such as coils or glue less suitable. Instead, Gelfoam was selected due to its ability to achieve diffuse embolisation. As an absorbable gelatin sponge, Gelfoam promotes mechanical occlusion and platelet aggregation, resulting in temporary cessation of blood flow. It is gradually resorbed over several weeks, allowing for revascularisation of the embolised tissue. In this case, Gelfoam was selected due to the diffuse distribution of pseudoaneurysms in the right hepatic lobe, necessitating embolisation at a lobar level. Permanent occlusion of a major hepatic artery carries a higher risk of significant liver ischaemia, particularly in patients without robust collateral supply. The use of Gelfoam mitigates this risk by allowing temporary haemostasis while preserving the potential for eventual reperfusion, which is particularly beneficial in older patients or those with limited hepatic reserve. This was reflected in the follow-up imaging, which showed only small areas of hepatic infarction and transient LFT derangement. Surveillance imaging is important to ensure no underlying liver lesions. Our literature search revealed a similar case of hepatic capsular avulsion following Video-assisted thoracoscopic surgery (VATS) [1]. In this case, the patient became systemically unwell with deranged LFTs. Surveillance imaging revealed infarction of the right hepatic lobe. Our patient did have small areas of hepatic infarction and mildly deranged LFTs which normalised after one week. Conclusion Spontaneous hepatic haemorrhage is a rare but life-threatening condition that requires rapid recognition and multidisciplinary management. This case demonstrates that transarterial embolisation with temporary agents such as Gelfoam can achieve effective haemostasis in the setting of diffuse pseudoaneurysm formation, while limiting the risk of long-term hepatic infarction. Careful follow-up is essential to exclude underlying hepatic pathology and to monitor recovery of liver function. Abbreviations ALT – Alanine aminotransferase AST – Aspartate aminotransferase CT – Computed tomography HELLP – Hemolysis, Elevated Liver Enzymes, and Low Platelets ICU – Intensive care unit LFT – Liver function test MRI – Magnetic resonance imaging VATS – Video-assisted thoracoscopic surgery Declarations Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Consent for publication Consent for publication was obtained for every individual person’s data included in the study. Availability of data and materials Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. Competing interests The authors declare that they have no competing interests. Funding This study was not supported by any funding. Authors' contributions DW was the major contributor in writing the manuscript. JA and DM reviewed the manuscript and provided critical feedback and suggestions. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Johnson M, Riccio J, Winter S, et al. Hepatic capsular avulsion after video-assisted thoracic biopsy of the lung. Ann Thorac Surg. 2015;99(3):1069–1071. doi:10.1016/j.athoracsur.2014.05.021. Al Tamimi A, Alawad AA. Large spontaneous subcapsular hematoma of the liver: A rare case report. Pan Afr Med J. 2019;32:16. doi:10.11604/pamj.2019.32.16.17083. Reck T, Baussenius-Kammerer M, Ott R, Müller V, Beinder E, Hohenberger W. Surgical treatment of HELLP syndrome-associated liver rupture–an update. Eur J Obstet Gynecol Reprod Biol. 2001;99:57–65. Onishi Y, Ikoma A, Takahashi H, et al. Transcatheter arterial embolization for subcapsular hematoma of the liver. Abdom Radiol (NY). 2022;48(2):765–772. doi:10.1007/s00261-022-03732-w. Wang MK, Baskaran G, Razeghi G, et al. Bleeding risks with non-vitamin K oral anticoagulants versus single antiplatelet therapy: A systematic review and meta-analysis of randomized trials. Ann Intern Med. 2025;178:360. Burrows-O’Donoghue, R., Donnison, R. and D’Almeida, E. (2023) ‘Spontaneous subcapsular hepatic haematoma: A rare case report’, European Medical Journal [Preprint]. doi:10.33590/emj/10300184. Cite Share Download PDF Status: Published Journal Publication published 13 Dec, 2025 Read the published version in CVIR Endovascular → Version 1 posted Reviewers agreed at journal 08 Sep, 2025 Reviewers invited by journal 08 Sep, 2025 Editor assigned by journal 28 Aug, 2025 First submitted to journal 28 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7310631","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":511931881,"identity":"caa59f0b-f402-4b75-8ed4-89c33a15112c","order_by":0,"name":"Darragh 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1","display":"","copyAsset":false,"role":"figure","size":295553,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal portal venous phase CT abdomen and pelvis showing hepatic laceration with ruptured capsule and subcapsular haematoma.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7310631/v1/fbab4649e22154a8838d7499.png"},{"id":91816607,"identity":"47128617-6da7-41dc-9f11-c559e29b3691","added_by":"auto","created_at":"2025-09-22 06:52:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":237949,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal maximum intensity projection (MIP) arterial phase CT liver showing multiple abnormal vessels at the capsular surface of the right hepatic lobe.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7310631/v1/b035be6e833142556ea88724.png"},{"id":91488248,"identity":"edc82dea-9580-4263-a8be-89c2b6ff6316","added_by":"auto","created_at":"2025-09-17 05:08:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":275148,"visible":true,"origin":"","legend":"\u003cp\u003eRight hepatic artery digital subtraction angiography (DSA) showing innumerable pseudoaneurysms overlying the entirety of the capsular surface of the right hepatic lobe.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7310631/v1/8dba671bda81618489b6ea2d.png"},{"id":91817065,"identity":"75e2b97e-c8aa-410f-b138-7a36f1312705","added_by":"auto","created_at":"2025-09-22 06:53:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":250375,"visible":true,"origin":"","legend":"\u003cp\u003eRight hepatic artery angiogram showing innumerable pseudoaneurysms overlying the entirety of the capsular surface of the right hepatic lobe.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7310631/v1/e6ee4ecdf2a55e229a57685d.png"},{"id":91816864,"identity":"28f2414f-d277-4b75-9c23-35494a02dce6","added_by":"auto","created_at":"2025-09-22 06:52:49","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":519802,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal T2 weighted MRI image (left) and coronal T1 weighted MRI with contrast showing a reduction in haematoma size and no underlying liver lesions.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7310631/v1/db5aff0e7f1ef4aa0168683c.png"},{"id":98244792,"identity":"855a9010-19a2-43db-a85e-e0794ada7f40","added_by":"auto","created_at":"2025-12-15 16:15:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2305561,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7310631/v1/0bc93ec6-38b4-4dc6-82fa-298fbadf2d92.pdf"}],"financialInterests":"","formattedTitle":"Spontaneous Hepatic Capsular Avulsion Requiring Emergency Embolisation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpontaneous hepatic haemorrhage is an uncommon but potentially fatal condition, typically associated with underlying liver pathology, trauma, or anticoagulation. Subcapsular haematomas may progress to capsular rupture and haemoperitoneum, with high associated morbidity and mortality. Prompt diagnosis and multidisciplinary management are essential to prevent further haemorrhage and organ compromise. This case highlights a rare presentation of spontaneous subcapsular liver haematoma with capsular rupture and pseudoaneurysm formation in a patient anticoagulated with rivaroxaban, successfully managed with trans arterial embolisation.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 78-year-old woman presented to the emergency department with sudden-onset abdominal pain, distension, and nausea. There was no history of trauma. Her medical history was significant for atrial fibrillation, and she was anticoagulated with Rivaroxaban. On arrival, she was tachycardic and hypotensive, with a systolic blood pressure of 60 mmHg. Her haemoglobin level had dropped to 6.4 g/dL, necessitating blood transfusion. Portal venous phase computed tomography (CT) of the abdomen and pelvis revealed a large subcapsular haematoma in segments 5/6 of the liver with rupture of the overlying capsule and associated haemoperitoneum. Triple-phase CT of the abdomen demonstrated multiple abnormal vessels underlying the haematoma, suspicious for active haemorrhage.\u003c/p\u003e\u003cp\u003eFollowing multidisciplinary input from general surgery, general medicine, and intensive care, the patient was transferred to interventional radiology for hepatic angiography and embolisation. Via a right common femoral artery approach, a 5 French C2 Glide catheter was used to select the coeliac artery and advanced into the right hepatic artery. Digital subtraction angiography revealed no active haemorrhage but demonstrated innumerable pseudoaneurysms along the capsular surface of the right hepatic lobe. Embolisation of the right hepatic artery was performed to stasis using Gelfoam.\u003c/p\u003e\u003cp\u003ePost-procedurally, the patient was transferred to the intensive care unit for monitoring. She remained haemodynamically stable and did not require further transfusion. Follow-up multiphase CT showed a stable haematoma with no residual perfusion of the pseudoaneurysms, though small areas of hepatic ischaemia were noted. Serial liver function tests post-procedure became mildly deranged with elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Bilirubin remained normal. Both ALT and AST normalised after one week. Elective outpatient magnetic resonance imaging (MRI) of the liver was performed six weeks post procedure which showed reduction in size of the liver haematoma and no underlying liver lesions or infarction.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSpontaneous subcapsular haematoma of the liver is a rare and life-threatening condition, typically associated with underlying liver lesions or occurring in the context of HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets) during pregnancy [6]. In the obstetric population, mortality from a ruptured subcapsular haematoma has been reported to range between 39% and 59% [3]. As the haematoma enlarges, shear forces may cause avulsion of the hepatic capsule from the underlying parenchyma, leading to tearing of intrahepatic or subcapsular arteries. This disruption in arterial wall integrity allows blood to escape into the surrounding tissue and form contained haematomas, known as pseudoaneurysms. Unlike true aneurysms, these lack all three arterial wall layers and are walled off by surrounding parenchyma or capsule. The resulting high-pressure arterial flow within these fragile structures increases the risk of ongoing or delayed haemorrhage. In this patient, the presence of innumerable pseudoaneurysms along the capsular surface of the right hepatic lobe likely reflects diffuse microvascular disruption secondary to subcapsular haematoma expansion and capsular rupture. Notably, the patient had a normal outpatient MRI two months prior to presentation, with no evidence of underlying liver disease or lesion. Spontaneous hepatic haematoma is exceedingly rare in patients without predisposing liver pathology. The estimated annual risk of spontaneous major haemorrhage while taking rivaroxaban is approximately 1%, only marginally higher than with aspirin [6].\u003c/p\u003e\u003cp\u003eManagement options for acute liver haemorrhage include conservative measures, angiography with embolisation and surgery. Hepatic artery embolisation is an effective treatment with one study demonstrating success rates of up to 94% [4]. In this case, the presence of numerous pseudoaneurysms without a single identifiable bleeding point made permanent embolic agents such as coils or glue less suitable. Instead, Gelfoam was selected due to its ability to achieve diffuse embolisation. As an absorbable gelatin sponge, Gelfoam promotes mechanical occlusion and platelet aggregation, resulting in temporary cessation of blood flow. It is gradually resorbed over several weeks, allowing for revascularisation of the embolised tissue. In this case, Gelfoam was selected due to the diffuse distribution of pseudoaneurysms in the right hepatic lobe, necessitating embolisation at a lobar level. Permanent occlusion of a major hepatic artery carries a higher risk of significant liver ischaemia, particularly in patients without robust collateral supply. The use of Gelfoam mitigates this risk by allowing temporary haemostasis while preserving the potential for eventual reperfusion, which is particularly beneficial in older patients or those with limited hepatic reserve. This was reflected in the follow-up imaging, which showed only small areas of hepatic infarction and transient LFT derangement.\u003c/p\u003e\u003cp\u003eSurveillance imaging is important to ensure no underlying liver lesions. Our literature search revealed a similar case of hepatic capsular avulsion following Video-assisted thoracoscopic surgery (VATS) [1]. In this case, the patient became systemically unwell with deranged LFTs. Surveillance imaging revealed infarction of the right hepatic lobe. Our patient did have small areas of hepatic infarction and mildly deranged LFTs which normalised after one week.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSpontaneous hepatic haemorrhage is a rare but life-threatening condition that requires rapid recognition and multidisciplinary management. This case demonstrates that transarterial embolisation with temporary agents such as Gelfoam can achieve effective haemostasis in the setting of diffuse pseudoaneurysm formation, while limiting the risk of long-term hepatic infarction. Careful follow-up is essential to exclude underlying hepatic pathology and to monitor recovery of liver function.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eALT \u0026ndash; Alanine aminotransferase\u003c/p\u003e\n\u003cp\u003eAST \u0026ndash; Aspartate aminotransferase\u003c/p\u003e\n\u003cp\u003eCT \u0026ndash; Computed tomography\u003c/p\u003e\n\u003cp\u003eHELLP \u0026ndash; Hemolysis, Elevated Liver Enzymes, and Low Platelets\u003c/p\u003e\n\u003cp\u003eICU \u0026ndash; Intensive care unit\u003c/p\u003e\n\u003cp\u003eLFT \u0026ndash; Liver function test\u003c/p\u003e\n\u003cp\u003eMRI \u0026ndash; Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eVATS \u0026ndash; Video-assisted thoracoscopic surgery\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eConsent \u0026nbsp;for publication was obtained for every individual person\u0026rsquo;s data included in the study.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was not supported by any funding.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eDW was the major contributor in writing the manuscript. JA and DM reviewed the manuscript and provided critical feedback and suggestions. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJohnson M, Riccio J, Winter S, et al. Hepatic capsular avulsion after video-assisted thoracic biopsy of the lung. Ann Thorac Surg. 2015;99(3):1069\u0026ndash;1071. doi:10.1016/j.athoracsur.2014.05.021.\u003c/li\u003e\n\u003cli\u003eAl Tamimi A, Alawad AA. Large spontaneous subcapsular hematoma of the liver: A rare case report. Pan Afr Med J. 2019;32:16. doi:10.11604/pamj.2019.32.16.17083.\u003c/li\u003e\n\u003cli\u003eReck T, Baussenius-Kammerer M, Ott R, M\u0026uuml;ller V, Beinder E, Hohenberger W. Surgical treatment of HELLP syndrome-associated liver rupture\u0026ndash;an update. Eur J Obstet Gynecol Reprod Biol. 2001;99:57\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eOnishi Y, Ikoma A, Takahashi H, et al. Transcatheter arterial embolization for subcapsular hematoma of the liver. Abdom Radiol (NY). 2022;48(2):765\u0026ndash;772. doi:10.1007/s00261-022-03732-w.\u003c/li\u003e\n\u003cli\u003eWang MK, Baskaran G, Razeghi G, et al. Bleeding risks with non-vitamin K oral anticoagulants versus single antiplatelet therapy: A systematic review and meta-analysis of randomized trials. Ann Intern Med. 2025;178:360.\u003c/li\u003e\n\u003cli\u003eBurrows-O\u0026rsquo;Donoghue, R., Donnison, R. and D\u0026rsquo;Almeida, E. (2023) \u0026lsquo;Spontaneous subcapsular hepatic haematoma: A rare case report\u0026rsquo;, \u003cem\u003eEuropean Medical Journal\u003c/em\u003e [Preprint]. doi:10.33590/emj/10300184. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Spontaneous hepatic haemorrhage, Subcapsular liver haematoma, Pseudoaneurysm, Trans arterial embolisation, Gelfoam embolisation, Rivaroxaban-related bleeding, Hepatic artery embolisation, Interventional radiology","lastPublishedDoi":"10.21203/rs.3.rs-7310631/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7310631/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSpontaneous hepatic haemorrhage is a rare and potentially fatal condition, most often associated with trauma or underlying liver disease. This case describes a 78-year-old woman on rivaroxaban who presented with haemodynamic shock due to a spontaneous subcapsular liver haematoma with capsular rupture and pseudoaneurysm formation. Imaging revealed multiple abnormal vessels without a single bleeding point. Trans arterial embolisation with Gelfoam was performed, achieving haemostasis without significant hepatic infarction. The patient remained stable post-procedure, with normalisation of liver function tests and no underlying liver neoplasm on follow-up imaging. This case underscores the importance of early diagnosis and multidisciplinary intervention. Temporary embolic agents such as Gelfoam offer effective haemostasis with lower risk of long-term hepatic injury in patients with diffuse microvascular disruption.\u003c/p\u003e","manuscriptTitle":"Spontaneous Hepatic Capsular Avulsion Requiring Emergency Embolisation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 05:07:58","doi":"10.21203/rs.3.rs-7310631/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-09-08T20:59:16+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-08T13:13:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-29T03:30:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"CVIR Endovascular","date":"2025-08-28T07:07:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"11a2349e-74bd-4fe4-ab10-376f3ed3360a","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:09:15+00:00","versionOfRecord":{"articleIdentity":"rs-7310631","link":"https://doi.org/10.1186/s42155-025-00617-z","journal":{"identity":"cvir-endovascular","isVorOnly":false,"title":"CVIR Endovascular"},"publishedOn":"2025-12-13 15:57:33","publishedOnDateReadable":"December 13th, 2025"},"versionCreatedAt":"2025-09-17 05:07:58","video":"","vorDoi":"10.1186/s42155-025-00617-z","vorDoiUrl":"https://doi.org/10.1186/s42155-025-00617-z","workflowStages":[]},"version":"v1","identity":"rs-7310631","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7310631","identity":"rs-7310631","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}