Large Hepatic Subcapsular Hematoma Following Endoscopic Retrograde Cholangiopancreatography: A Case Report

Abstract

For decades, endoscopic retrograde cholangiopancreatography (ERCP) has been the cornerstone in the treatment of several biliopancreatic diseases. Although it is a relatively safe procedure, there are certain hazards involved. Hepatic subcapsular hematoma (HSH) is an uncommon complication of ERCP, with only a few cases reported in the literature to date. We present here a case of large HSH that developed 48 hours after an otherwise uneventful ERCP for choledocholithiasis. After being apparently well for the first two days post-ERCP, the patient began to develop abdominal pain and restlessness associated with hemodynamic instability and a decline in hemoglobin levels. Computed tomography (CT) confirmed the presence of a large HSH. The patient was managed nonsurgically with vascular angioembolization followed by ultrasoundguided percutaneous catheter drainage of hematoma. This case highlights the necessity of increasing awareness about this complication in order to aid in early diagnosis and management.

Hepatic subcapsular hematoma following endoscopic retrograde cholangiopancreatography. Report of two cases

“…In addition, other rare but relevant complications emerge, such as pneumothorax, pneumomediastinum and hepatic subcapsular hematoma. Within this spectrum, HSH emerges as a low frequency complication, but of consideration after ERCP [ 3 ].…”

“…Its overall complication rate stands at around 6.85 % with a morbidity of between 6.27 % and 7.51 % and a case-fatality rate of up to 21.4 % [ 1 , 2 ]. HSH is an uncommon but dreaded post-ERCP complication, until now, 67 cases have been reported worldwide and its mechanism is still unclear, so the identification of risk factors, patterns of presentation and successful treatment approaches may improve the safety and efficacy of medical procedures [ [3] , [4] , [5] , [6] , [7] , [8] , [9] ]. In this case series, this study presents two cases of post-ERCP HSH, a procedure indicated by a diagnosis of choledocholithiasis, one ruptured and one non-ruptured, which occurred at the same center and in the same month.…”

Hepatic subcapsular hematoma: A rare complication post-ERCP; a case report

“…[2] According to a recent multicentric database registry for ERCP in Japan, the overall complication rate of ERCP is 10.6%, with a 30-day mortality rate of 1.1%. [3,4] Post-ERCP HSH is an extremely rare complication that was first described in the year 2000 [5] and has only a few case reports in the literature. [6] We present the case of a 79-year-old female patient who developed a 37 mm HSH 24 hours after ERCP.…”