Injury to the liver and spleen after diagnostic ERCP

Abstract

R Re ef fe er re en nc ce es s

Untitled

“…The first case of post-ERCP splenic injury was reported in 1988, 2 and since then, 11 cases of ERCP-related splenic injury have been reported. [3][4][5][6][7][8][9][10][11][12][13] This is the first case of ERCP-related splenic injury reported postorthotopic liver transplant. The intraoperative findings are varied, with cases of splenic laceration or rupture, 2,4-7,11-13 and avulsion of the splenic vessels, 8 splenic capsule avulsion as a result of intraabdominal adhesions and adherence of the splenic capsule to the anterior abdominal wall, 9 splenic injury complicated by a subcapsular splenic abscess, 10 and avulsion of the short gastric vessels.…”

“…"Bowing" of the endoscope in the "long" position with torsion on the greater curvature of the stomach may lead to splenic vessel or capsular avulsion by traction on the short gastric vessels. [7][8][9]11 Inflation of the stomach has been suggested as a possible mechanism, exerting tension on the greater curve of the stomach. 10,11 It also may occur when the procedure is not technically difficult secondary to traction of adhesions.…”

Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography

“…Similar to colonoscopy, splenic injury following ERCP usually causes the formation of a subcapsular splenic hematoma, abscess [15,16], splenic laceration or tear [12,14,17], splenic rupture [18], avulsion of the splenic capsule [11,19], and avulsion of short gastric vessels [20,21]. All patients with splenic injury developed abdominal pain after procedure, although abdominal distension, acute decrease in hemoglobin, hemodynamic instability, and syncope were also observed [11,12,[17][18][19][20][21]. The diagnosis was made via computed tomography (CT) at various intervals following ERCP, ranging from 20 minutes to 3 days [12].…”

Rotura esplénica durante colangiopancreato-grafía retrógrada endoscópica

“…Se han comunicado ocho roturas esplénicas en el transcurso de una colangiopancreatografía retrógrada endoscópica (CPRE) (2)(3)(4)(5)(6)(7)(8). La primera descripción fue en 1989 por Tronasen, el cual describe este cuadro tras CPRE.…”

“…El diagnóstico se ha realizado en los diferentes casos por ecografía abdominal, TAC, laparoscopia y angiografía, pero la laparotomía exploradora de urgencia a menudo ha sido necesaria para diagnóstico y tratamiento (2)(3)(4)(5)(6)(7)(8). Comprobamos que en los ocho casos descritos, en seis ha sido necesaria la realización de laparotomía con esplenectomía para la resolución del cuadro.…”