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Hepatic subcapsular hematoma: A rare complication post-ERCP; a case report.

Georgio El Koubayati¹, Tatiana Charbel², Antoine Aoun³

¹Faculty of Medical Sciences, Lebanese University, Hadath Campus, Beirut, Lebanon.

|March 29, 2024

Summary

A rare but fatal complication of Endoscopic Retrograde Cholangiopancreatography (ERCP) is hepatic subcapsular hematoma. This case highlights the importance of considering this diagnosis in patients with sudden abdominal pain post-ERCP.

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Area of Science:

Gastroenterology
Interventional Endoscopy
Surgical Complications

Background:

Endoscopic retrograde cholangiopancreatography (ERCP) is a common diagnostic and therapeutic procedure.
ERCP is associated with complications in up to 10% of patients.
Sphincterotomy is a frequent intervention during ERCP.

Observation:

A patient developed sudden sharp abdominal pain and dropping hemoglobin levels 24 hours after ERCP and sphincterotomy for choledocholithiasis.
Emergent gastroscopy excluded bleeding from the sphincterotomy site.
Computed tomography revealed a large hepatic subcapsular hematoma.

Findings:

The patient's condition rapidly deteriorated despite resuscitation.
The patient demised on day 4 post-ERCP.
Hepatic subcapsular hematoma is a rare, potentially fatal ERCP complication.

Implications:

Clinicians must consider hepatic subcapsular hematoma in patients presenting with abdominal pain and hemodynamic instability after ERCP.
Early diagnosis and management are crucial for patients with suspected post-ERCP hepatic subcapsular hematoma.
This case underscores the critical need for vigilance regarding rare but severe ERCP-related complications.