Successful embolisation of a spontaneous diffuse subcapsular liver bleeding in a patient receiving rivaroxaban.

Spontaneous hepatic haemorrhage is a rare and potentially fatal condition. 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. Transarterial 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.