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Subcapsular Hepatic Hematoma Post-Endoscopic Retrograde Cholangiopancreatography Requiring Surgical Necrosectomy
1Department of UGI Surgery, Liverpool Hospital, Sydney, NSW 2170, Australia.
Insights
This case report details an extremely rare subcapsular hepatic hematoma following endoscopic retrograde cholangiopancreatography (ERCP). Surgical intervention was ultimately required for successful management of this rare complication.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Interventional Radiology
Background:
- Cholelithiasis is a prevalent gastrointestinal condition.
- Symptomatic gallstones can lead to serious complications like cholangitis and pancreatitis.
- Endoscopic retrograde cholangiopancreatography (ERCP) is a common treatment for common bile duct stones.
Observation:
- Hepatic hematomas are an exceptionally rare complication of ERCP, with fewer than 50 cases reported.
- This report focuses on a 43-year-old female with an ERCP-associated subcapsular hepatic hematoma.
- Initial non-operative management and interventional radiology drainage were unsuccessful.
Findings:
- The patient developed sepsis and required laparoscopic necrosectomy and drain placement.
- Prolonged antibiotic therapy and drain irrigation led to near-complete resolution of the infected collection.
- This case underscores the rarity of surgical intervention for post-ERCP hepatic hematomas.
Implications:
- This case highlights the potential need for aggressive surgical management in rare, severe ERCP complications.
- Successful surgical outcomes are possible even in complex cases of hepatic hematoma.
- Further research into preventative strategies and optimal management algorithms for rare ERCP complications is warranted.
Abstract:
Cholelithiasis is a common gastrointestinal pathology with a prevalence of over 6% in the USA. Symptomatic patients can develop cholangitis, biliary colic, pancreatitis and cholecystitis. Surgical management involves laparoscopic or open cholecystectomy. Stones within the common bile duct can be treated with endoscopic retrograde cholangiopancreatography (ERCP). Well-known ERCP complications include pancreatitis, perforation, bleeding and cholangitis. Hepatic hematomas as a complication of ERCP are extremely rare, with fewer than 50 reported cases in the literature. Approximately 22% have required operative management. We present an extremely rare case of ERCP-associated subcapsular hepatic hematoma in a 43-year-old lady that was initially non-operatively managed. She did not improve with antibiotics alone and underwent attempted interventional radiology drainage. Despite this, due to on-going sepsis, the patient underwent laparoscopic necrosectomy and drain placement with continued post-operative irrigation. After a long course of antibiotics and drain irrigation, the patient was discharged with repeated computed tomography imaging showing almost total resolution of the infected collection. This case highlights the extreme rarity of surgical management for post-ERCP subcapsular hepatic hematoma and its successful outcome.
