Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review

Abstract

Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients' haemodynamic and clinic.

Keywords: Abdominal pain; Embolization; Endoscopic guidewire; Endoscopic retrograde cholangiopancreatography; Subcapsular hepatic hematoma.

Figure 1

Urgent abdomen computed tomography scan. A: Hepatic subcapsular hematoma of the right lobe (14 cm × 6 cm × 19 cm) with peripheral parenchymal laceration. Ab-extrinsic compression of the right and middle hepatic vein with perisplenic free fluid; B: Six days after radiological selective embolization: note the stability of the haematoma dimension with disappearance of perisplenic free fluid.