523 - Liver Clot and Hemostatic Agents: A case report

A liver clot is a post-operative extraction complication that leads to a dark red, jelly-like pedunculated mass extruding from a recently extracted socket due to an incomplete fibrin clot. Although rare, a liver clot can lead to excessive bleeding as a result of the venous reactionary or secondary hemorrhage. It can be attributed to many factors, including an inability to follow post-operative instructions, infection, intrinsic trauma, or the presence of a foreign body at the site. A liver clot is treated by complete removal of the clot. If hemostasis is not achieved at the site after removal, other forms of local hemostatic agents are indicated such as gel foam, sutures, lasers, and electrocautery. Hemostatic agents available can be categorized as chemical, mechanical or thermal. If hemostasis is not achieved with local measures, systemic measures are indicated, especially in children with complex medical history.
This case report describes the diagnosis, evaluation, and treatment of a liver clot in a 7 year 10 month old male who reports to the University of Michigan Pediatric Dental clinic with the chief complaint of excessive bleeding 3 days after extraction of #L. The mother of the patient contacted the emergency after-hours line. The patient was triaged over the phone to provide at-home care and scheduled the next day. A clinical exam revealed a liver clot at the site of #L. This case report discusses hemostatic techniques available, clinical findings of a liver clot, and treatment rendered to a patient with post-extraction complications.