Hepatic Subcapsular Hematoma: A Rare Complication After ERCP: A Case Report and Review of Literature

Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for diagnosing and treating biliary and pancreatic disorders, yet it carries a risk of complications, including the rare development of subcapsular hepatic hematoma (SHH). We report the case of a 32-year-old woman who presented with abdominal pain following ERCP for gallstone pancreatitis. She was afebrile and hemodynamically stable but appeared pale and exhibited right upper quadrant and epigastric tenderness. Laboratory evaluation revealed a hemoglobin drop to 8.6 g/dL. Computed tomography demonstrated a large right-lobe subcapsular hepatic hematoma measuring 15.5 × 7.5 cm with associated air locules. Despite initial conservative management, the hematoma enlarged, and the patient subsequently underwent laparoscopic cholecystectomy with evacuation of the infected hematoma 3 days after admission. This case highlights the importance of early clinical vigilance and prompt imaging in the detection of post-ERCP complications. Although conservative therapy may be effective in stable cases, surgical intervention becomes essential when complications progress or infection develops.