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El Koubayati G, Charbel T, Aoun A, Choueiry R. Hepatic subcapsular hematoma: A rare complication post-ERCP; a case report. Medicine (Baltimore) 2024; 103:e37705. [PMID: 38552039 PMCID: PMC10977585 DOI: 10.1097/md.0000000000037705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/04/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used in gastroenterology wards for both diagnostic and therapeutic purposes. It doesn't however come free of complications. As a matter of fact, complications are reported in up to 10% of patients undergoing ERCP. PATIENT CONCERNS In this article, we report the case of a patient who underwent ERCP and sphincterotomy for choledocholithiasis. Twenty-four hours after the procedure, the patient developed sudden sharp abdominal pain and dropped her hemoglobin levels. DIAGNOSIS An emergent gastroscopy was done and it ruled out bleeding from the sphincterotomy. Computed tomography of the abdomen showed a large hepatic subcapsular hematoma. INTERVENTIONS Blood was urgently transfused and the patient was transferred to the intensive care unit for monitoring. OUTCOMES The patient's condition quickly deteriorated despite extensive resuscitative measures, and eventually passed away on day 4 post ERCP. LESSONS Hepatic subcapsular hematoma is a very rare but fatal complication after ERCP and should be ruled out in patients who underwent the procedure and develop sudden abdominal pain with hemodynamic and laboratory instability.
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Affiliation(s)
- Georgio El Koubayati
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Beirut, Lebanon
| | - Tatiana Charbel
- Faculty of Medical Sciences, Université Saint Joseph, Beirut, Lebanon
| | - Antoine Aoun
- Gastroenterology Department, Dr. Serhal Hospital, Beirut, Lebanon
| | - Randa Choueiry
- Faculty of Medical Sciences, Lebanese University, Hadath Campus, Beirut, Lebanon
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Sotelo-Carbajal J, Hernández-Zamora RE, Montaño-García NE, López-Prida JA, Acosta-Aguirre EF, Torres-Salazar QL. Hepatic subcapsular hematoma following endoscopic retrograde cholangiopancreatography. Report of two cases. Int J Surg Case Rep 2023; 111:108856. [PMID: 37742351 PMCID: PMC10520530 DOI: 10.1016/j.ijscr.2023.108856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hepatic subcapsular hematomas (HSH) are an extremely rare post-endoscopic retrograde cholangiopancreatography (ERCP) complication. Mortality exhibits disparities depending on the integrity of the hepatic capsular envelope, with ruptured HSH being associated with higher case fatality rates (2.2 % compared to 21.4 %). CASES PRESENTATION Two clinical cases are presented concerning a 20-year-old female patient and a 40-year-old male patient, who were diagnosed with choledocholithiasis and underwent ERCP procedures with the use of a wide-bore guidewire (WBG), with the undesired result of HSH as a complication. In both scenarios, a surgical approach strategy was chosen to manage this situation. The outcome turned out to be successful in the first case, in contrast to the unfortunate death of the patient in the second case. CLINICAL DISCUSSION AND CONCLUSIONS Conservative approaches prevail in the management of HSH, as they often present intact, resulting in a low mortality rate. However, surgical approaches are reserved for consideration in situations of hemodynamic instability that persists despite the conservative measures implemented.
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Affiliation(s)
- Jorge Sotelo-Carbajal
- Hospital General Regional No. 1 Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
| | | | | | - Juan Antonio López-Prida
- Hospital General Regional No. 1 Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
| | - Eddy Fredy Acosta-Aguirre
- Hospital General Regional No. 1 Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
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Arya R, Priyadarshi RN, Maji T, Kumar R, Anand U. Large Hepatic Subcapsular Hematoma Following Endoscopic Retrograde Cholangiopancreatography: A Case Report. Cureus 2022; 14:e21920. [PMID: 35273865 PMCID: PMC8901137 DOI: 10.7759/cureus.21920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/02/2022] Open
Abstract
For decades, endoscopic retrograde cholangiopancreatography (ERCP) has been the cornerstone in the treatment of several biliopancreatic diseases. Although it is a relatively safe procedure, there are certain hazards involved. Hepatic subcapsular hematoma (HSH) is an uncommon complication of ERCP, with only a few cases reported in the literature to date. We present here a case of large HSH that developed 48 hours after an otherwise uneventful ERCP for choledocholithiasis. After being apparently well for the first two days post-ERCP, the patient began to develop abdominal pain and restlessness associated with hemodynamic instability and a decline in hemoglobin levels. Computed tomography (CT) confirmed the presence of a large HSH. The patient was managed nonsurgically with vascular angioembolization followed by ultrasound-guided percutaneous catheter drainage of hematoma. This case highlights the necessity of increasing awareness about this complication in order to aid in early diagnosis and management.
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Intraparenchymal hepatic hematoma following endoscopic retrograde cholangiopancreatography: Risk factors and conservative approach in acute management. Hepatobiliary Pancreat Dis Int 2021; 20:293-295. [PMID: 32988762 DOI: 10.1016/j.hbpd.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023]
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Pivetta LGA, da Costa Ferreira CP, de Carvalho JPV, Konichi RYL, Kawamoto VKF, Assef JC, Ribeiro MA. Hepatic subcapsular hematoma post-ERCP: Case report and literature review. Int J Surg Case Rep 2020; 72:219-228. [PMID: 32544833 PMCID: PMC7298556 DOI: 10.1016/j.ijscr.2020.05.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed minimally invasive procedures currently available for diagnosis and treatment of biliary and pancreatic diseases. Though considered a safe procedure, it has the highest rate of complications among the other endoscopic procedures, such as duodenal perforation and hepatic subcapsular hematoma (HSH). We are a presenting a case report and review of the current literature. METHOD We report one case HSH rupture, in a 25 years old female patient, 15 cm in diameter, affecting liver segments VI, VII and VIII, who underwent surgical treatment and performed a systematic literature review with the descriptors: endoscopic retrograde colangiopancreatography and hepatic subcapsular hematoma. All articles were reviewed and data on cases that presented rupture of the HSH analyzed separately. RESULTS Sixty one cases of HSH were described in the literature, fourteen of them ruptured. When analyzing only the subgroup of patients who had ruptured subcapsular hematoma, we showed a significant increase in the mortality rate of patients when compared to non-ruptured (21.4% × 2.2%). We also report that patients with rupture required some type of intervention, of which 78.6% required surgery. Conservative treatment may be the conduct and will suffice for most cases of non-ruptured hematomas. For patients who evolve with rupturing, surgical resolution, although non-mandatory, is necessary in most cases. CONCLUSION HSH ruptured is a rare and potentially fatal post-ERCP complication whose treatment is eminently surgical.
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Affiliation(s)
| | | | | | | | | | - Jose Cesar Assef
- Emergency Service of the Irmandade da Santa Casa de São Paulo (ISCMSP), São Paulo, SP, Brazil
| | - Mauricio Alves Ribeiro
- Emergency Service of the Irmandade da Santa Casa de São Paulo (ISCMSP), São Paulo, SP, Brazil
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Caroço TV, Louro JM, Coelho MI, Costa Almeida CE. Rare case of hepatic haematoma following endoscopic retrograde cholangiopancreatography. BMJ Case Rep 2018; 2018:bcr-2017-222638. [PMID: 29669766 PMCID: PMC5911147 DOI: 10.1136/bcr-2017-222638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/04/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used diagnostic and therapeutic technique but it is not free of complications. Subcapsular hepatic haematoma is a rare but potentially fatal complication. A 71-years-old male patient resorted to the emergency department 36 hours after an uneventful ERCP presenting with severe abdominal pain and haemoglobin drop. Abdominal ultrasound and CT scan diagnosed a subcapsular hepatic haematoma. The patient was haemodynamically normal and was successfully treated with a conservative management. Signs and symptoms of hepatic haematoma following ERCP are non-specific. The most common symptom is abdominal pain. Abdominal CT, ultrasound or MRI make the diagnosis. Conservative management is possible if the patient is stable, nevertheless invasive treatment such as surgery or angiographic embolisation, may be required. A low threshold of suspicion is crucial for an early diagnosis and treatment. Fatal cases have been described but most patients have a favourable outcome.
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Affiliation(s)
- Teresa Vieira Caroço
- Cirurgia C, Hospital Geral (Covões) - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Serviço de Cirurgia Geral, Instituto Português de Oncologia de Coimbra Francisco Gentil E.P.E, Coimbra, Portugal
| | - João Mendes Louro
- Cirurgia C, Hospital Geral (Covões) - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria Inês Coelho
- Cirurgia C, Hospital Geral (Covões) - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography. A rare complication with high morbidity and mortality. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:23-27. [PMID: 29502888 DOI: 10.1016/j.gastrohep.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 02/03/2023]
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Intrahepatic subcapsular biloma after endoscopic retrograde cholangiopancreatography treated by endoscopic biliary drainage. Clin J Gastroenterol 2017; 11:167-171. [PMID: 29188552 DOI: 10.1007/s12328-017-0806-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
Several major complications from endoscopic retrograde cholangiopancreatography (ERCP), including pancreatitis, cholangitis, and hemorrhage have been discussed in detail; however, a few uncommon but severe complications have been reported. We encountered an unusual case of post-ERCP intrahepatic subcapsular biloma. An 89-year-old woman with a 25-mm mass located at the hepatic hilum, suggestive of cholangiocarcinoma, underwent ERCP which demonstrated complete stricture of the common hepatic duct. Subsequently, two plastic stents were placed from the common bile duct to the right and left intrahepatic branches. On day 3, serum inflammatory markers were elevated and computed tomography revealed a large subcapsular fusiform fluid collection in the right liver, consistent with biloma. On day 6, the biloma ruptured and 500 ml of biliary ascites were removed. On day 8, endoscopic nasobiliary drainage via the right intrahepatic branch was performed because of recurrence of biliary ascites. After the procedure, 150 ml of bile was collected through the drain every day and no ascites recurred. We believe that minor injury to the right intrahepatic bile duct due to guidewire manipulation caused the biloma. Biloma may become apparent several days after ERCP, and endoscopic biliary drainage placement adjacent to the bile duct rupture site can stop bile leakage.
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Fiorini M, Pietrangelo A, Vegetti A. An unfortunate case of post-ERCP complications. Intern Emerg Med 2017; 12:263-265. [PMID: 27286868 DOI: 10.1007/s11739-016-1474-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/20/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Massimo Fiorini
- Internal Medicine 2, Center for Hemochromatosis, University Hospital of Modena, Via del Pozzo 71, Modena, MO, Italy.
| | - Antonello Pietrangelo
- Internal Medicine 2, Center for Hemochromatosis, University Hospital of Modena, Via del Pozzo 71, Modena, MO, Italy
| | - Alberto Vegetti
- Internal Medicine 2, Center for Hemochromatosis, University Hospital of Modena, Via del Pozzo 71, Modena, MO, Italy
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A.M. A, A.A. A, M.F. A, S.A. A. Subcapsular left hepatic lobe hematoma: A potentially life-threatening post-ERCP complication. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2017. [DOI: 10.5348/ijhpd-2017-71-cr-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Zappa MA, Aiolfi A, Antonini I, Musolino CD, Porta A. Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review. World J Gastroenterol 2016; 22:4411-4415. [PMID: 27158211 PMCID: PMC4853700 DOI: 10.3748/wjg.v22.i17.4411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/26/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
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.
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Zizzo M, Lanaia A, Barbieri I, Zaghi C, Bonilauri S. Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography: A Case Report and Review of Literature. Medicine (Baltimore) 2015; 94:e1041. [PMID: 26131812 PMCID: PMC4504646 DOI: 10.1097/md.0000000000001041] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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.
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Affiliation(s)
- Maurizio Zizzo
- From the Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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