Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography: A Case Report and Review of Literature

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the diagnosis and treatment of biliary-pancreatic diseases. ERCP-related complications total around 2.5% to 8%, with a mortality rate ranging from 0.5% to 1%. An exceptional ERCP complication is subcapsular hepatic hematoma, and few cases are reported worldwide.We present the case of a 52-year-old woman with a history of recurring upper abdominal pain and a clinical and ultrasonographic diagnosis of obstructive jaundice due to common bile duct stones. After 2 difficult endoscopic biliary procedures, common bile duct stones clearance was obtained. Post-ERCP course was symptomatic with upper abdominal pain and anemization with hemodynamic instability.CT scan demonstrated a 15 cm × 11 cm subcapsular hepatic hematoma filled with air and liquid on the surface of the right hepatic lobe. The patient was successfully treated with the embolization of a small branch of right hepatic artery angiographically identified as the cause of bleeding.Subcapsular hepatic hematoma after ERCP is a rare complication that must be taken into account in the differential diagnosis of symptomatic cases after ERCP. Its diagnosis is based on clinical and laboratory data and especially on imaging (ultrasound, CT, or MRI). Treatment is often conservative but, in some cases, embolization or percutaneous drainage or surgery may be necessary.

FIGURE 1

CT scan of upper abdomen showing a subcapsular hepatic hematoma (hypodense area indicated by the arrows) in which is present a source of active bleeding (circle). CT = computed tomography.

FIGURE 2

CT scan of middle abdomen showing a subcapsular hepatic hematoma on the surface of the right lobe of liver (hypodense area indicated by the arrows) in which is present a source of active bleeding (circle). CT = computed tomography.

FIGURE 3

CT scan of upper abdomen showing a reduction of subcapsular hepatic hematoma (hypodense area indicated by the arrows), mainly on the surface of the right lobe of liver. There are no sources of active bleeding. CT = computed tomography.