A post-endoscopic retrograde cholangiopancreatography subcapsular hepatic hematoma

Abstract

Nowadays endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive technique with a complication rate around 2.5% in expert hands, being the most frequent: acute pancreatitis, cholangitis, hemorrhage and perforation. An exceptional complication is subcapsular hepatic hematoma, first published in the literature in 2000, with few cases reported. Regarding the case published by Del Moral Martínez et al (Hepatic Hematoma after ERCP: presentation of two new cases. Rev Esp Enferm Dig 2017, Vol. 109, No. 6, pp. 470-473) we would like to contribute a reflection based on a recent clinical case in our center.

A potential complication following endoscopic retrograde cholangiopancreatography: Subcapsular hepatic hematoma

“…In these cases, most patients survived and only three patients deceased [6][7][8][9][10]. Although the mortality rate of complication could be low, it is still potentially lifethreatening.…”

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

“…Al. 2016 [ 15 ] 58 years Female Choledocholithiasis Yes 12 h Hypotension and tachycardia Embolization No Fei BY, Li CH., et al 2013 [ 16 ] 56 years Male Choledocholithiasis Yes 2 h Fever Image-guided drainage No González R., et al 2015 [ 17 ] 30 years Female Bile duct stenosis Yes 72 h Abdominal pain Surgical, packaging Si Caroço TV, et al 2018 [ 21 ] 71 Male NR NC 36 h Abdominal pain Conservative management No Roldán et al 2019 [ 22 ] 51 Male Choledocholithiasis Yes 48 h Abdominal pain and hypotension Surgical, hemoperitoneum evacuation and decapsulation No Soler et al 2017 [ 23 ] 37 years Female Choledocholithiasis Yes 6 h Abdominal pain Conservative management No Soler et al 2017 [ 23 ] 60 years Female Choledocholithiasis Yes 6 días Abdominal pain Image-guided drainage No Zizzo M, et al 2015 [ 24 ] 52 years Female Choledocholithiasis Yes 24 h Abdominal pain Embolization No Baudet JS, et al 2011 [ 25 ] 69 years …”

Evaluation of Clinical Indications of Three Treatments for Choledocholithiasis with Acute Cholangitis

“…Coagulation disorders, use of anticoagulants before and within 3 days after ERCP and active cholangitis are considered risk factors for bleeding, and intraoperative injury to blood vessels is also a common cause of bleeding. [22][23][24][25] For patients with a high risk of bleeding, it is advisable to avoid Oddi sphincterotomy whenever possible. In case of bleeding, priority is given to microscopic hemostasis, which can be done with electrocoagulation, titanium clips, balloon compression, etc.…”