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Case Reports
. 2001 Apr-Jun;5(2):171-3.

Rare complications of endoscopic retrograde cholangiopancreatography: two case reports

D D Kingsley  1 , C R Schermer, M M Jamal
Affiliations
Case Reports

Rare complications of endoscopic retrograde cholangiopancreatography: two case reports

D D Kingsley et al. JSLS. 2001 Apr-Jun.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure with several known risks. We present two rarely reported complications of ERCP and sphincterotomy: transverse mesocolon disruption with ischemic colitis and splenic rupture.

Results: The first patient, a 54-year-old female, presented one day following ERCP and stent revision for pancreas divisum. She presented with hypotension and abdominal distention. An abdominal computed tomography (CT) showed a ruptured spleen, which was confirmed on laparotomy. She had a complicated postoperative course and died of multiple organ failure. The second patient is a 56-year-old female who presented five days after ERCP and sphincterotomy with abdominal pain, abdominal wall ecchymosis, and decreasing hematocrit. Her evaluation included hospital admission and abdominal CT scan, which showed free fluid and a large hematoma in the transverse mesocolon. These findings were confirmed on laparotomy and a devascularized segment of bowel was resected.

Conclusion: Only 6 cases of ERCP-related splenic injury have been reported in the literature. One additional report is available of a fatal splenic artery injury. No previous reports exist of a mesenteric hematoma resulting in bowel devascularization. Prompt evaluation and awareness of potential complications should help capture potentially life-threatening sequelae of ERCP.

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Figures

Figure 1.
Figure 1.
Abdominal CT, axial view, showing hemoperitoneum and splenic rupture
Figure 2.
Figure 2.
Abdominal CT, axial view, showing a mesenteric hematoma in the transverse mesocolon and compromised bowel.
See this image and copyright information in PMC

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