Etiologies and risks of splenic decapsulation after endoscopic retrograde cholangiopancreatography: case report and literature review

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and interventional procedure used in conditions related to the pancreas and biliary tract. It has a complication rate ranging from 4 % to 10 %. Severe complications are few with the most common of them being post-ERCP pancreatitis, post-sphincterotomy bleeding, and perforation. A rare, but potentially life-threatening complication of ERCP is splenic injury. We report the case of a 60-year-old female with choledocholithiasis who sustained splenic decapsulation following ERCP. The exact causes of splenic injury are unknown, although several mechanisms are postulated. A literature review of splenic injuries post-ERCP shows that there are only 3 cases with post-ERCP splenic decapsulation. Our patient is the first one in whom splenic decapsulation occurred without any risk factors or technical difficulties during the procedure. A high index of suspicion for splenic injury is required in any patient who has severe pain, anemia, or hemorrhagic shock after ERCP.

Endoscopic retrograde cholangiopancreatography induced splenic injury: comprehensive analysis and new perspectives based on a case report

“…Although many possible predisposing factors seem to contribute to post-ERCP splenic injury, some cases are more complicated with no difficulties or known predisposing factors. 14 , 43 – 45 In our case, the endoscopist was skilled, and ERCP was performed without any difficulties. Furthermore, no risk factor was known.…”

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

“…One potential explanation that fits with the case presented involves the bowing and torsion of the endoscope while attempting to cannulate a difficult hepato-pancreatic ampulla. During this procedure, torsion on the greater curvature of the stomach will translate to direct forces on the surrounding organs, including the splenic capsule and vasculature [6]. Another potential explanation is that of anatomical changes secondary to chronic pancreatitis.…”

Splenic Hematoma as a Rare Complication of Endoscopic Retrograde Cholangiopancreatography

“…The most likely mechanism is a traction injury along the greater curvature of the stomach. Risk factors include intra-abdominal adhesions, prior foregut surgery, chronic pancreatitis, and/or cirrhosis [7][8][9][10]. Traction injuries to the liver and transverse colon mesentery have also been rarely described after ERCP.6 Other possible mechanisms include the avulsion of splenic/ short gastric vessels as well as what has been described as the "bowing" of the endoscope as it passes through to the duodenum, and the placing of the endoscope in the "long" position as the papilla is cannulated [5,7].…”