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

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Clinically significant hemorrhagic complications associated usually to previous papillotomy are uncommon. Subcapsular hepatic hematoma is excepcional, with only twenty cases described. We present a case of a 52-year-old man who developed a large subcapsular liver hematoma following a therapeutic ERCP. Due to serious anemization and hemodynamic instability, arterial embolization and finally urgent surgical evacuation of the hematoma were performed. In the postoperative period the patient presented infection of the collection, which indicated colocation of percutaneous drainage and broad-spectrum intravenous antibiotics, and gradually recovered.

Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography

“…Since 2000, when subcapsular hepatic hematoma was first described, 3 world literature has not reported more than 20 cases. 2 – 19 In this case report, we describe: a further rare case of subcapsular hepatic hematoma manifested only with abdominal pain as first symptom, in accordance with most clinical presentations of similar cases already described; an analysis of the possible pathophysiological mechanism and a review of present research literature.…”

“…A clinically significant bleeding complication associated with ERCP and sphincterotomy records an approximately 2% rate, according to the different cases, although an endoscopically visible but not clinically detectable bleeding is more commonly detected, ranging from 10% to 30% of all sphincterotomies. 19 , 20 By skilled experienced hands, bleeding or hematoma associated with ERCP and involving liver, spleen, intestinal wall, or abdominal cavity turn out to be an extremely rare but potentially serious event which requires prompt recognition and treatment. Subcapsular hepatic hematoma represents an exceptional event, of which world literature described 21 cases (Table 1 ).…”

Subcapsular left hepatic lobe hematoma: A potentially life-threatening post-ERCP complication

“…No laboratory test provide reliable indicators of the development of a subcapsular hepatic hematoma, except for a decrease in the hemoglobin level [10,11]. The management is conservative for most of the cases as we did in our case.…”

Subcapsular Hepatic Hematoma Following Endoscopic Retrograde Cholangiopancreatography

“…The etiology of the hematoma is not entirely clear. Most of the authors claim that it is caused by rupture of small caliber vessels due to the guide wire trauma [8][9][10]. Presence of air in the hematoma and growth of Citrobacter freundii from hematoma are supporting this idea [5].…”

“…Patients are generally hemodynamically stable unless hematoma expands more. If the size of hematoma increases rapidly, hypotension, tachycardia and anemia may be seen [8].…”