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DOI: 10.1055/s-0030-1256267
© Georg Thieme Verlag KG Stuttgart · New York
Subcapsular hepatic hematoma following ERCP: case report and review
D. Pozo PrietoMD
Aparato Digestivo
Hospital Universitario Príncipe
de Asturias,
Alcalá de Henares,
28805
Madrid,
Spain
Fax: +34-91-8801825
eMail: dpozo.hupa@salud.madrid.org
Publikationsverlauf
Publikationsdatum:
11. Mai 2011 (online)
A 76-year-old woman, who was receiving anticoagulation for atrial fibrillation, was referred to our center for management of a common bile duct stone diagnosed by endoscopic ultrasonography. Anticoagulation was suspended and endoscopic retrograde cholangiopancreatography (ERCP) was subsequently performed. Cannulation of the main bile duct with a 0.035-inch guide wire was achieved without complications. Endoscopic biliary sphincterotomy was performed and stone extraction with a Fogarty catheter was achieved successfully, without apparent complications. Subsequently, the patient developed sharp right upper quadrant pain 6 hours after the procedure, but showed no signs of hemodynamic instability, and laboratory data did not show any evidence of complications. By 24-hours after the procedure, she was asymptomatic and was discharged after the reintroduction of anticoagulation.
The patient consulted again 5 days later because of persistent pain. Abdominal examination elicited mild right upper quadrant pain without tenderness. Laboratory data showed hemoglobin 9.6 g/dL (normal range 12 – 15 g/dL) and hematocrit 30.7 % (normal range 36 – 41 %). Computed tomography showed two high-density collections consistent with hematomas within the subdiaphragmatic and subhepatic spaces ([Fig. 1]). The patient was managed conservatively. Anticoagulation was discontinued and a broad-spectrum antibiotic (piperacillin–tazobactam) was administered. The patient was discharged 15 days after the ERCP, without any further complications.
![](https://www.thieme-connect.de/media/endoscopy/2011S02/thumbnails/974cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 1 Computed tomography showing subdiaphragmatic and subhepatic hematomas.
Subcapsular hepatic hematoma is a rare complication of ERCP. There are few published reports of this unusual complication [1] [2] [3] [4] [5] [6] [7] [8] [9] [10], which may be explained by accidental puncture of the intrahepatic biliary tree by the guide wire. In this case, the patient probably developed an initial hematoma 6 hours after the procedure, which worsened because of the resumption of anticoagulation.
From the literature [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] ([Table 1]), there is unanimous concern about the risk of infection in these patients, and in all cases, except two where no detail was given, patients were treated with antibiotics. Most of the patients including our own (6/11) were observed; three were treated by percutaneous drainage; and one each by embolization and surgery. There were no long term complications.
Age/ Sex | Indication for ERCP | Guide wire | Puncture | Treatment | Antibiotic | |
Ortega et al. 2000 [1] | 81/M | Common bile duct stone | NA | Yes, positive culture | Percutaneous drainage | Yes |
Horn et al. 2004 [2] | 88/F | Pancreatic cyst | Yes | No | Observation | Yes |
Chi et al. 2004 [3] | 43/F | Pancreatic cancer | Yes | No | Embolization | Yes |
Priego et al. 2007 [4] | 30/F | Obstructive jaundice | NA | No | Surgery, positive culture | Yes |
Petit-Laurent et al. 2007 [5] | 98/M | Common bile duct stone | Yes | Yes, negative culture | Percutaneous drainage | NA |
Bhati et al. 2007 [6] | 51/F | Common bile duct stone | Yes | Yes, negative culture | Percutaneous drainage | NA |
McArthur et al. 2008 [7] | 71/M | Common bile duct stone | Yes | No | Observation | Yes |
De la Serna et al. 2008 [8] | 71/F | Common bile duct stone | Yes | Yes, negative culture | Observation | Yes |
Cárdenas et al. 2008 [9] | 54/M | Bile leak post liver transplant | Yes | No | Observation | Yes |
Revuelto et al. 2010 [10] | 41/M | Common bile duct stone | NA | No | Observation | Yes |
Current report | 76/F | Common bile duct stone | Yes | No | Observation | Yes |
M, male; F, female; NA, details not available. |
Endoscopy_UCTN_Code_TTT_1AU_2AC
Competing interests: None
#References
- 1 Ortega Deballon P, Fernández Lobato R, García Septiem J et al. Liver hematoma following endoscopic retrograde cholangiopancreatography (ERCP). Surg Endosc. 2000; 14 767
- 2 Horn T L, Peña L R. Subcapsular hepatic hematoma after ERCP: case report and review. Gastrointest Endosc. 2004; 59 594-596
- 3 Chi K D, Waxman I. Subcapsular hepatic hematoma after guidewire injury during endoscopic retrograde cholangiopancreatography: management and review. Endoscopy. 2004; 36 1019-1021
- 4 Priego P, Rodríguez G, Mena A et al. Subcapsular liver hematoma after ERCP. Rev Esp Enferm Dig. 2007; 99 53-54
- 5 Petit-Laurent F, Scalone O, Penigaud M, Barbeys J. Subcapsular hepatic hematoma after endoscopic retrograde cholangiopancreatography: case report and literature review. Gastroenterol Clin Biol. 2007; 31 750-752
- 6 Bhati C S, Inston N, Wigmore S J. Subcapsular intrahepatic hematoma: an unusual complication of ERCP. Endoscopy. 2007; 39 (Suppl 1) E150
- 7 McArthur K S, Mills P R. Subcapsular hepatic hematoma after ERCP. Gastrointest Endosc. 2008; 67 379-380
- 8 De La Serna-Higuera C, Fuentes Coronel A, Rodríguez Gómez S J, Martín Arribas M I. Subcapsular hepatic hematoma secondary to the use of hydrophilic guidewires during endoscopic retrograde cholangiopancreatography. Gastroenterol Hepatol. 2008; 31 266-267
- 9 Cárdenas A, Crespo G, Balderramo D et al. Subcapsular liver hematoma after Endoscopic Retrograde Cholangiopancreatography in a liver transplant recipient. Ann Hepatol. 2008; 7 386-388
- 10 Revuelto Rey J, Gordillo Escobar E, Batalha P. Subcapsular hepatic hematoma after ERCP. Med Intensiva. 2010; 34 224
D. Pozo PrietoMD
Aparato Digestivo
Hospital Universitario Príncipe
de Asturias,
Alcalá de Henares,
28805
Madrid,
Spain
Fax: +34-91-8801825
eMail: dpozo.hupa@salud.madrid.org
References
- 1 Ortega Deballon P, Fernández Lobato R, García Septiem J et al. Liver hematoma following endoscopic retrograde cholangiopancreatography (ERCP). Surg Endosc. 2000; 14 767
- 2 Horn T L, Peña L R. Subcapsular hepatic hematoma after ERCP: case report and review. Gastrointest Endosc. 2004; 59 594-596
- 3 Chi K D, Waxman I. Subcapsular hepatic hematoma after guidewire injury during endoscopic retrograde cholangiopancreatography: management and review. Endoscopy. 2004; 36 1019-1021
- 4 Priego P, Rodríguez G, Mena A et al. Subcapsular liver hematoma after ERCP. Rev Esp Enferm Dig. 2007; 99 53-54
- 5 Petit-Laurent F, Scalone O, Penigaud M, Barbeys J. Subcapsular hepatic hematoma after endoscopic retrograde cholangiopancreatography: case report and literature review. Gastroenterol Clin Biol. 2007; 31 750-752
- 6 Bhati C S, Inston N, Wigmore S J. Subcapsular intrahepatic hematoma: an unusual complication of ERCP. Endoscopy. 2007; 39 (Suppl 1) E150
- 7 McArthur K S, Mills P R. Subcapsular hepatic hematoma after ERCP. Gastrointest Endosc. 2008; 67 379-380
- 8 De La Serna-Higuera C, Fuentes Coronel A, Rodríguez Gómez S J, Martín Arribas M I. Subcapsular hepatic hematoma secondary to the use of hydrophilic guidewires during endoscopic retrograde cholangiopancreatography. Gastroenterol Hepatol. 2008; 31 266-267
- 9 Cárdenas A, Crespo G, Balderramo D et al. Subcapsular liver hematoma after Endoscopic Retrograde Cholangiopancreatography in a liver transplant recipient. Ann Hepatol. 2008; 7 386-388
- 10 Revuelto Rey J, Gordillo Escobar E, Batalha P. Subcapsular hepatic hematoma after ERCP. Med Intensiva. 2010; 34 224
D. Pozo PrietoMD
Aparato Digestivo
Hospital Universitario Príncipe
de Asturias,
Alcalá de Henares,
28805
Madrid,
Spain
Fax: +34-91-8801825
eMail: dpozo.hupa@salud.madrid.org
![](https://www.thieme-connect.de/media/endoscopy/2011S02/thumbnails/974cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 1 Computed tomography showing subdiaphragmatic and subhepatic hematomas.