Endoscopic Retrograde Cholangiopancreatography–Induced Splenic Injury in a Patient With Sleeve Gastrectomy

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure with significant complications. Splenic hematoma is an extremely rare but known complication following ERCP that has been increasingly reported in the past several years. We report the case of a 44-year-old patient with a history of sleeve gastrectomy who underwent an ERCP that was complicated by both acute pancreatitis and splenic hematoma. She was managed conservatively under close monitoring in the intensive care unit. Clinicians should be aware of this potentially life-threatening complication to make a prompt diagnosis and begin early appropriate management.

An Unexpected Complication of Endoscopic Retrograde Cholangiopancreatography with a Novel Treatment Approach

“…Signs and symptoms that a clinician team can look for are left upper quadrant abdominal pain, epigastric pain, and hemodynamic instability. However, these signs and symptoms are not specific and overlap with common complications of ERCP, including pancreatitis, post-sphincterotomy bleeding, and esophageal/duodenal perforation [4]. Symptoms may present promptly after the procedure or may insidiously appear over a few days.…”

Sleeve gastrectomy prior to liver transplantation is superior to medical weight loss in reducing posttransplant metabolic complications

“…One LT recipient who had undergone pre-LT SG required ERCP in the perioperative period after LT, without complication, limiting our ability to evaluate for ERCP-induced splenic injury which has previously been described in a patient after SG. 12 Change in weight and BMI following LT is listed in Table 4. While both cohorts demonstrated weight loss between listing and time of LT, the percentage total body weight loss was greater in the SG cohort (22.6% vs. 9.7%, p = .001).…”

Splenic Hematoma as a Rare Complication of Endoscopic Retrograde Cholangiopancreatography

“…Given continued pain, magnetic resonance cholangiopancreatography was performed. This revealed dilated intrahepatic and common bile duct (1.6 cm) with short seg-plication rate for an ERCP [2] and an overall mortality rate between 0.5%-1% [3]. Splenic injury as a complication of ERCP was initially described in the late 1980s [4].…”

“…Splenic injury as a complication of ERCP was initially described in the late 1980s [4]. There have been approximately 20 reported cases of post-ERCP splenic injury [3].…”

“…Diagnosis of a post-ERCP splenic injury is often delayed and is confirmed by cross sectional imaging [3,5,6]. The most likely mechanism is a traction injury along the greater curvature of the stomach.…”