Hepatic subcapsular hematoma following endoscopic retrograde cholangiopancreatography. Report of two cases

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.

Imaging Features and Interventional Treatment for Liver Injuries and Their Complications

Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.

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

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.