Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the diagnosis and treatment of biliary-pancreatic diseases. ERCP-related complications total around 2.5% to 8%, with a mortality rate ranging from 0.5% to 1%. An exceptional ERCP complication is subcapsular hepatic hematoma, and few cases are reported worldwide.We present the case of a 52-year-old woman with a history of recurring upper abdominal pain and a clinical and ultrasonographic diagnosis of obstructive jaundice due to common bile duct stones. After 2 difficult endoscopic biliary procedures, common bile duct stones clearance was obtained. Post-ERCP course was symptomatic with upper abdominal pain and anemization with hemodynamic instability.CT scan demonstrated a 15 cm × 11 cm subcapsular hepatic hematoma filled with air and liquid on the surface of the right hepatic lobe. The patient was successfully treated with the embolization of a small branch of right hepatic artery angiographically identified as the cause of bleeding.Subcapsular hepatic hematoma after ERCP is a rare complication that must be taken into account in the differential diagnosis of symptomatic cases after ERCP. Its diagnosis is based on clinical and laboratory data and especially on imaging (ultrasound, CT, or MRI). Treatment is often conservative but, in some cases, embolization or percutaneous drainage or surgery may be necessary.

Subcapsular Hepatic Hematoma Following Endoscopic Retrograde Cholangiopancreatography

“…Subcapsular hepatic hematomaafter ERCP is extremely uncommon and was firstly described in 2000 [5]. Since then more than 20 cases were reported in the literature [3], and just one of them is from Turkey [6]. Here we report an unusual case of post-ERCP hepatic subcapsular hematoma.…”

“…Most common complications related to ERCP are pancreatitis, cholangitis, perforation and bleeding due to the papillotomy [2]. Complications related to this procedure vary from 2.5% to 8%, with a mortality rate of 0.5% to 1% [3][4]. Subcapsular hepatic hematomaafter ERCP is extremely uncommon and was firstly described in 2000 [5].…”

A potential complication following endoscopic retrograde cholangiopancreatography: Subcapsular hepatic hematoma

“…Previous studies have explained that subcapsular hepatic hematoma was related to infections from accidental puncture with non-sterile guide-wire and resulting in rupture of small intrahepatic vessels during endoscopy procedure in all cases worldwide [3]. Interestingly, the systematic review and metaanalysis reported that the prophylactic effectiveness of the nonsteroidal anti-inflammatory drugs can reduce the pancreatitis following ERCP [12].…”

“…Endoscopic Retrograde Cholangiopancreatography (ERCP), which was introduced into the field of gastroenterology, hepatology and hepato-pancreatico-biliary surgery, has progressed to be an important and essential diagnostic and therapeutic tool for biliary and pancreatic diseases but haemorrhagic complications usually occurs when utilizing Endoscopic Sphincterotomy (EST) or Endoscopic Papillotomy (EPT) [1][2][3][4]. The complication of subcapsular hepatic hematoma after conducting ERCP is uncommon and a likely life-threatening situation in which few cases was reported in the world [5].…”

Subcapsular left hepatic lobe hematoma: A potentially life-threatening post-ERCP complication

“…The ERCP-related complications around 2.5-9%, with a mortality rate ranging from 0.6-1% [1]. Post-ERCP pancreatitis, perforation, cholangitis and post-sphincterotomy bleeding are the most frequently described complications [2,3].…”