Correspondence

Hepatic Hematoma after Deep Tissue Massage

N Engl J Med 1999; 341:2019-2020December 23, 1999

Article

To the Editor:

Common causes of hepatic hematoma include trauma and rupture of a hepatic tumor (adenoma or hepatoma). We report a case of hepatic hematoma that developed after a deep body massage.

A 39-year-old woman who had no history of serious disorders and no liver problems or bleeding disorders and who was not taking any medications underwent a deep body massage that included massage of the abdomen and right upper quadrant. Within 24 hours, vague abdominal discomfort and nausea developed, with pain in the right shoulder. She went to her local hospital 72 hours after the massage for evaluation of persistent abdominal symptoms. The results of laboratory tests included a hematocrit of 23 percent, a white-cell count of 10,600 per cubic millimeter, a platelet count of 448,000 per cubic millimeter, an albumin level of 3.8 g per deciliter, an alanine aminotransferase level of 41 IU per liter, an aspartate aminotransferase level of 76 IU per liter, a prothrombin time of 11.2 seconds, a partial-thromboplastin time of 23.7 seconds, and an alpha-fetoprotein level of less than 2.5 ng per milliliter. An abdominal computed tomographic scan showed a large hematoma, 14 by 18 cm, in the right hepatic lobe (Figure 1Figure 1Abdominal Computed Tomographic Scan Showing a Large Hematoma in the Right Hepatic Lobe in a Woman Who Had Undergone Deep Body Massage.). Celiac-axis arteriography and magnetic resonance imaging of the abdomen showed no evidence of hemangioma, adenoma, or intrahepatic lesions other than the hematoma. The patient received 2 units of packed red cells. Over the next six months, she lost 10.4 kg (23 lb) as a result of nausea and had daily low-grade fevers (temperature, 37.2° to 37.7°C [99° to 100°F]). The patient is currently afebrile; she has returned to her initial body weight and has fully recovered.

The number of patients seeking alternative medical therapies has increased, and numerous adverse effects have been reported in the medical literature.1 Therapeutic body massage has become a popular treatment for a variety of disorders and is gaining acceptance by the medical community. In fact, my medical center provides this service on demand for inpatients. The incidence of adverse effects of body massage is not known, but it is probably quite low. However, the following complications have been reported after massage: displacement of a ureteral stent,2 renal-artery embolization,3 posterior interosseous syndrome,4 and popliteal-artery pseudoaneurysm.5 Practitioners whose patients undergo massage therapy should be aware of these potential complications.

James F. Trotter, M.D.
University of Colorado Health Sciences Center, Denver, CO 80262

5 References

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Citing Articles (3)

Citing Articles

1. 1

   Alice Running, Elizabeth Turnbeaugh. (2011) Oncology Pain and Complementary Therapy. Clinical Journal of Oncology Nursing 15:4, 374-379
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2. 2

   Tian Yang, Junhua Lu, Feng Shen, Mengchao Wu. (2011) A large asymptomatic hepatic mass. Liver Internationaln/a-n/a
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3. 3

   2006. Complementary and alternative medicine. , 886-899.
   CrossRef