Subcapsular Hepatic Hematoma Post-ERCP: Case Report and Review of the Literature

Dig Dis Sci. 2019 Aug;64(8):2114-2119. doi: 10.1007/s10620-019-05679-3.

Abstract

Introduction: Hepatic hematoma is a rare but possible complication of ERCP. We describe the case of a 75-year old man with a large, 8 × 12 cm, sub-capsular and intra-parenchymal hematoma post ERCP, affecting the right liver segments and treated conservatively.

Areas covered: A review of literature has been performed, highlighting two possible mechanisms: hematoma may occur as the result of accidental laceration of a small intrahepatic vessel by the guidewire, whereas the other hypothesis posits that the hepatic damage is secondary to traction on the biliary system exerted by the balloon. We speculate that in case of anomalies of the biliary tree, the incidence of this complication is higher than expected.

Expert commentary: In case of hepatic hematoma post ERCP, a conservative approach should always be considered before proceeding to interventional radiologic procedures or to surgical therapy.

Keywords: Abdominal pain; ERCP; Endoscopic procedure; Hepatic hematoma; Pancreatitis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Cholangiopancreatography, Endoscopic Retrograde* / adverse effects
  • Conservative Treatment
  • Contrast Media
  • Hematoma / diagnostic imaging*
  • Hematoma / drug therapy
  • Humans
  • Liver Diseases / diagnostic imaging
  • Liver Diseases / drug therapy
  • Male
  • Tomography, X-Ray Computed
  • Ultrasonography

Substances

  • Anti-Bacterial Agents
  • Contrast Media