Complication from Procedure: Renal Hematoma

Introduction: Subcapsular and perirenal hematomas are complications of kidney biopsy. We present a case of a subcapsular hematoma following TIPS thrombectomy in a Budd-Chiari syndrome patient. Case Description: A 53-year-old female with CKD II, hypertension, polycythemia vera, cirrhosis, and Budd-Chiari syndrome with TIPS, presented with right upper quadrant pain. Imaging showed TIPS thrombosis, requiring a heparin drip. A thrombectomy attempt was aborted due to an unpassable clot. She became hypotensive, and a CT scan indicated a large subcapsular hematoma of the right kidney with active bleeding. The heparin drip was stopped, and she received pRBCs and pressor support. An emergent angiogram resulted in coil embolization of the middle segmental branch of the renal artery, resolving her shock. Post-embolization angiogram showed stopped bleeding and stable hematoma size. She had developed AKI due to hemorrhagic shock and raised concerns about renal compression from the hematoma. No intervention for the hematoma was recommended, and CRRT was initiated, later transitioning to hemodialysis. After a month, her kidney function improved to baseline, and a repeat abdominal CT showed resolution of the subcapsular hematoma. Discussion: This case highlights a rare subcapsular hematoma post-TIPS thrombectomy in a Budd-Chiari syndrome patient. The hematoma and AKI likely resulted from hemorrhagic shock, potentially exacerbated by kidney compression. Key takeaways include: 1) Recognizing complications in complex vascular patients. 2) Rapid identification and management of complications. 3) Engaging a multidisciplinary team, including interventional radiology, nephrology, and critical care. 4) Renal recovery is possible with supportive treatment after significant injury. This case enhances understanding of rare TIPS complications and emphasizes tailored management for complex hepatic and renal conditions.