Subcapsular hepatic hematoma after ERCP (endoscopic retrograde cholangipancreatography)

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive technique useful for the diagnosis and treatment of biliary and pancreatic diseases (1). The appearance of a liver hematoma after performing ERCP is extremely rare, with only 5 cases reported in the literature since 2000, when it was described the first case (2). We report a case of subcapsular hepatic hematoma that required surgery to control bleeding.

Subcapsular Hepatic Hematoma after ERCP: A Case Report and Revision of Literature

“…In the previously reported cases, three [7] [12] [13] were treated surgically and four [2] [8] [14] [15] were treated with percutaneous drainage.…”

Rare case of hepatic haematoma following endoscopic retrograde cholangiopancreatography

“…Surgical treatment involves an adequate drainage of the haematoma and local haemostasis with electrocauterisation and/or other haemostatic means, or packing in cases of massive haemorrhage 2 5 19. Follow-up with CT scan is recommended to monitor eventual appearance of a residual collection or rebleeding 2. In the case presented by the authors, patient’s haemodynamic stability allowed a conservative treatment, with the 10 months’ follow-up CT scan showing a complete resolution of the haematoma.…”

Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography

“…Subcapsular hepatic hematoma is another rare complication following ERCP, and there are only a handful of reported cases in the literature [22][23][24][25][26][27][28][29][30][31]. Similar to subcapsular splenic hematoma and laceration, these patients presented with abdominal pain, syncope, hemodynamic instability, and a decrease in hemoglobin.…”

“…In addition to conservative therapy, 2 patients required percutaneous drainage [26,30] and 1 patient required hepatic artery embolization [24]. Only 2 patients required exploratory laparotomy for evacuation of the hematoma [28,31] and therefore, surgical exploration may be reserved for patients with hemodynamic compromise or free intra-abdominal fluid or blood [26,28,31].…”

“…Similar to subcapsular splenic hematoma and laceration, these patients presented with abdominal pain, syncope, hemodynamic instability, and a decrease in hemoglobin. Diagnosis requires cross-sectional imaging after symptoms develop anywhere from minutes to 5 days following ERCP [22][23][24][25][26][27][28][29][30][31].…”