Hepatic hematoma following endoscopic retrograde cholangiopancreatography: overview and case report

Carlos A. Cordova-Velazquez; Ana S. Reyes-Perez; Hadassa H. García-Rivera; Adrian Regalado-Aquino; José A. Velázquez-García

doi:10.18203/2320-6012.ijrms20230890

Authors

Carlos A. Cordova-Velazquez Department of Surgery, National Medical Center “La Raza”, Mexico City, México
Ana S. Reyes-Perez Department of Surgery, National Medical Center “La Raza”, Mexico City, México https://orcid.org/0000-0001-7584-7968
Hadassa H. García-Rivera Department of Medical and Surgical Emergencies, National Medical Center “La Raza”, Mexico City, México https://orcid.org/0000-0002-0551-8138
Adrian Regalado-Aquino Department of Surgery, National Medical Center “La Raza”, Mexico City, México https://orcid.org/0000-0002-5116-5185
José A. Velázquez-García Department of Surgery, National Medical Center “La Raza”, Mexico City, México https://orcid.org/0000-0003-1564-8347

DOI:

https://doi.org/10.18203/2320-6012.ijrms20230890

Keywords:

Hepatic hematoma, Laparotomy, ERCP, Subcapsular hematoma, Hemostasis

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure with a high risk of complications. Hepatic subcapsular hematoma is an infrequent complication, with few cases reported in the international literature. Treatment can be conservative with the patient under close surveillance in an intensive care unit and surgical management is reserved for failure of conservative treatment and cases with hemodynamic instability. We present a case of subcapsular and intraparenchymal hepatic hematoma in an adult male who presented sudden hemodynamic instability, associated with hemoglobin decrease, which required surgical management. The challenge in the therapeutic decision due to sudden hemodynamic instability is clearly demonstrated; therefore, there was a need for surgical treatment as the best measure of hemorrhage control. Conservative management should be reserved for hemodynamically stable patients and invasive management by interventional radiology or surgery for cases of acute abdomen associated with hemodynamic instability.

Metrics

Metrics Loading ...

References

Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70:80-88.

Ortega Deballon P, Fernández Lobato R, García Septiem J, Nieves Vázquez MA, Martínez Santos C, Moreno Azcoita M. Liver hematoma following endoscopicretrograde cholangiopancreatography (ERCP). Surg Endosc. 2000;14:767.

McArthur KS, Mills PR. Subcapsular hepatic hematoma after ERCP. Gastrointest Endosc. 2008;67:379-80.

Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T et al. Complications of ERCP. Gastrointest Endosc. 2012;75:467-73.

Chi KD, Waxman I. Subcapsular hepatic hematoma after guide wire injury during endoscopic retrograde cholangiopancreatography: Management and review. Endoscopy. 2004;36(11):1019-21.

Orellana F, Irarrazaval J, Galindo J, Balbontin P, Manríquez L, Plass R et al. Subcapsular hepatic hematoma post ERCP: a rare or an underdiagnosed complication? Endoscopy. 2012;44.

Fei BY, Li CH. Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography: an unusual case. World J Gastroenterol. 2013;19:1502-4.

Sommariva C, Lauro A, Pagano N, Vaccari S, Andrea V, Marino I et al. Subcapsular Hepatic Hematoma Post-ERCP: Case Report and Review of the Literature. Digestive Dis Sci. 2019;64:2114-9.

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;94:1041.

Díaz Alcázar MDM, Martín-Lagos Maldonado A, Ruiz-Escolano E. Subcapsular hepatic hematoma as a complication of ERCP: what do we know about its etiology? Rev Esp Enferm Dig. 2021;113(2):149-50.

Imperatore N, Micheletto G, Manes G. Systematic review: Features, diagnosis, management and prognosis of hepatic hematoma, a rare complication of ERCP. Dig Liver Dis. 2018;50(10):997-1003.

Del Moral Martínez M, Delgado Maroto A, Cervilla Sáez de Tejada ME. Hepatic hematoma after ERCP: Two new case reports. Rev Esp Enferm Dig. 2017;109(6):470-3.

Fernández-Enriquez ER, Bada-Yllán O, López Y López MA. Subcapsular hepatic hematoma after endoscopic retrograde cholangiopancreatography; a rare intraoperative finding. Rev Gastroenterol Mex (Engl Ed). 2021;86(1):92-4.

Oliveira-Ferreira A, Tato-Marinho R, Velosa J. Infected hepatic hematoma 10 days after ERCP. Endoscopy. 2013;45:402-3.

Del Pozo D, Moral I, Poves E, Sanz C, Martín M. Subcapsular hepatic hematoma following ERCP: Case report and review. Endoscopy. 2011;43(2):E164-5.

Petrucci R, Das A. Subcapsular Hepatic Hematoma Post-Endoscopic Retrograde Cholangiopancreatography Requiring Surgical Necrosectomy. J Med Cases. 2021;12(5):186-9.

Pivetta LGA, Da Costa Ferreira CP, De Carvalho JPV, Konichi RYL, Kawamoto VKF, Assef JC. Hepatic subcapsular hematoma post-ERCP: Case report and literature review. Int J Surg Case Rep. 2020;72:219-8.

Khrais A, Ali A, Choi C, Verma S. Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Subcapsular Hepatic Hematoma. Cureus. 2022;14(11):e31691.

Roldán Villavicencio JI, Prieto Calvo M, Gastaca Mateo M. Post-ERCP hepatic subcapsular hematoma, from conservative therapy to emergency surgery: an unusual though extremely serious complication. Rev Esp Enferm Dig. 2019;111(9):721-3.